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    The use of history to identify anterior cruciate ligament injuries in the acute trauma setting: the 'LIMP index'

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    Publication date
    2017
    Author
    Ayre, Colin A.
    Hardy, Maryann L.
    Scally, Andy J.
    Radcliffe, G.
    Venkatesh, R.
    Smith, J.
    Guy, S.
    Keyword
    Anterior cruciate ligament; Delayed diagnosis; ACL
    Rights
    (c) 2017 The Authors. Full-text reproduced in accordance with the publisher's self-archiving policy.
    Peer-Reviewed
    Yes
    
    Metadata
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    Abstract
    Objective To identify the injury history features reported by patients with ACL injuries and determine whether history may be used to identify patients requiring follow-up appointments from acute trauma services. Multi-site cross-sectional service evaluation using a survey questionnaire design conducted in the UK. The four injury history features investigated (LIMP) were ‘Leg giving way at the time of injury’, ‘Inability to continue activity immediately following injury’, ‘Marked effusion’ and ‘Pop (heard or felt) at the time of injury’. 194 patients with ACL injury were identified of which 165 (85.5%) attended an acute trauma service. Data on delay was available for 163 (98.8%) of these patients of which 120 (73.6%) had a follow-up appointment arranged. Patients who had a follow-up appointment arranged waited significantly less time for a correct diagnosis (geometric mean 29 vs 198 days; p<0.001) and to see a specialist consultant (geometric mean 61 vs 328 days; p<0.001). Using a referral threshold of any 2 of the 4 LIMP injury history features investigated, 95.8% of patients would have had a follow-up appointment arranged. Findings support the value of questioning patients on specific injury history features in identifying patients who may have suffered ACL injury. Using a threshold of 2 or more of the 4 LIMP history features investigated would have reduced the percentage of patients inappropriately discharged by 22.2%. Evidence presented suggests that this would significantly reduce the time to diagnosis and specialist consultation minimising the chance of secondary complications.
    URI
    http://hdl.handle.net/10454/11344
    Version
    Accepted Manuscript
    Citation
    Ayre C, Hardy ML, Scally AJ et al (2017) The use of history to identify anterior cruciate ligament injuries in the acute trauma setting: the 'LIMP index'. Emergency Medicine Journal. 34(5): 302-307.
    Link to publisher’s version
    http://dx.doi.org/10.1136/emermed-2015-205610
    Type
    Article
    Collections
    Health Studies Publications

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