We have located links that may give you full text access.
Evaluation Study
Journal Article
The saline load test of the knee redefined: a test to detect traumatic arthrotomies and rule out periarticular wounds not requiring surgical intervention.
Journal of Orthopaedic Trauma 2013 September
OBJECTIVE: To describe the use of the saline load test (SLT) using a new definition that more adequately characterizes its use in the emergency department (ED) setting.
DESIGN: Retrospective review.
SETTING: Level I trauma center.
PATIENTS/PARTICIPANTS: Fifty consecutive patients who underwent an SLT of the knee in the ED and had a minimum of 14 days follow-up.
INTERVENTION: Saline Load Test.
MAIN OUTCOME MEASUREMENTS: Positive traumatic arthrotomy of the knee (+TAK) defined as operating room (OR) confirmation of an arthrotomy (assumed to develop a septic knee) or -SLT with follow-up revealing a septic knee. Periarticular wound equivalent to no traumatic arthrotomy of the knee [pw = (-TAK)] defined as OR evaluation revealing no arthrotomy (assumed not to develop a septic knee) or -SLT whose follow-up revealed no septic knee. Development of a septic knee was considered the gold standard for determining true positives/negatives and false positives/negatives.
RESULTS: The mean wound size was 3.9 ± 4.3 cm and the mean saline load volume was 74.9 ± 28.2 cm. There were 19 +SLTs of which there were 16 +TAK and 3 pw = (-TAK). The 3 pw = (-TAK) in the +SLT group were evaluated in the OR where inspection of the joint capsule revealed the absence of a traumatic arthrotomy. There were 31 -SLTs of which there were 1 +TAK and 30 pw = (-TAK). The SLT has a sensitivity of 94% and a specificity of 91% for detecting +TAKs and ruling out periarticular wounds not requiring surgical intervention [pw = (-TAK)]. The false-positive rate of the SLT to detect +TAK is 9%.
CONCLUSIONS: Using +TAK and pw = (-TAK) as the newly defined measures of the SLT, we report the sensitivity (94%) and specificity (91%) of the SLT in the ED setting while still maintaining the clinical relevancy of the test. Based on a small sample size, knees with small periarticular wounds and a -SLT and no other radiographic or clinical evidence of an arthrotomy appear to have an infection rate of 0% with nonoperative management.
LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective review.
SETTING: Level I trauma center.
PATIENTS/PARTICIPANTS: Fifty consecutive patients who underwent an SLT of the knee in the ED and had a minimum of 14 days follow-up.
INTERVENTION: Saline Load Test.
MAIN OUTCOME MEASUREMENTS: Positive traumatic arthrotomy of the knee (+TAK) defined as operating room (OR) confirmation of an arthrotomy (assumed to develop a septic knee) or -SLT with follow-up revealing a septic knee. Periarticular wound equivalent to no traumatic arthrotomy of the knee [pw = (-TAK)] defined as OR evaluation revealing no arthrotomy (assumed not to develop a septic knee) or -SLT whose follow-up revealed no septic knee. Development of a septic knee was considered the gold standard for determining true positives/negatives and false positives/negatives.
RESULTS: The mean wound size was 3.9 ± 4.3 cm and the mean saline load volume was 74.9 ± 28.2 cm. There were 19 +SLTs of which there were 16 +TAK and 3 pw = (-TAK). The 3 pw = (-TAK) in the +SLT group were evaluated in the OR where inspection of the joint capsule revealed the absence of a traumatic arthrotomy. There were 31 -SLTs of which there were 1 +TAK and 30 pw = (-TAK). The SLT has a sensitivity of 94% and a specificity of 91% for detecting +TAKs and ruling out periarticular wounds not requiring surgical intervention [pw = (-TAK)]. The false-positive rate of the SLT to detect +TAK is 9%.
CONCLUSIONS: Using +TAK and pw = (-TAK) as the newly defined measures of the SLT, we report the sensitivity (94%) and specificity (91%) of the SLT in the ED setting while still maintaining the clinical relevancy of the test. Based on a small sample size, knees with small periarticular wounds and a -SLT and no other radiographic or clinical evidence of an arthrotomy appear to have an infection rate of 0% with nonoperative management.
LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Full text links
Related Resources
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app