I have seen more research from a global perspective focused on physical therapists in the emergency room. This particular study may help the clinicians practicing in this environment.
When someone goes to the emergency room, they have made the decision that their current problem is not something that they or their family is able to manage. The patient and family will be worried and scared. The expectations will be high that something will be done.
The clinician needs to be able to listen and hear the patient’s story. High levels of fear and anxiety need to be managed. A skillful, thorough examination needs to happen. Sometimes no intervention or diagnostic test is required. Sometimes only advice and education is required. The role of the emergency room clinician is to know is and when diagnostic testing is required.
This particular article should pull together the information that is currently available to successfully manage patients who present to the emergency room with a knee injury.
The abstract is included below for you to review.
Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series).
Knee injuries are a common presentation to the ED and are often difficult to assess and definitively diagnose due to the patient’s acute pain, effusion and guarding. The quality of ED care provided to patients with fractures or soft tissue injuries of the knee is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common knee injuries in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 2250 articles, of which 54 were included in the review (n = 8 primary articles, n = 28 systematic reviews, n = 18 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the knee in the ED, a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is consistent evidence to support undertaking a thorough history and physical examination, including the application of special tests and clinical decision rules for imaging. In the undifferentiated knee injury, expedited follow up and further imaging is recommended to improve patient outcomes and cost-effectiveness.
Emerg Med Australas. 2018 Jun;30(3):327-352. doi: 10.1111/1742-6723.12870. Epub 2017 Dec 15.
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