Title : Evaluating the Cambridge Knee Injury Tool (CamKIT) for triage of soft tissue knee injury referrals to fracture clinic
Abstract:
Background: Soft Tissue Knee Injury (STKI) referrals generate substantial fracture clinic workload, though many can be safely managed conservatively or via physio led services at a lower cost. Referrals from the Emergency Department (ED) and community are often made without structured triage. Early stratification of knee injury severity is essential for guiding appropriate investigation and management. This study aimed to retrospectively evaluate how the Cambridge Knee Injury Tool (CamKIT) performs in stratifying referrals to fracture clinic at a DGH.
Methods: Single-center retrospective observational study of 100 randomly selected patients referred to fracture clinic with suspected STKI between January 2025 and February 2026. Demographics, history, mechanisms and examination findings at index presentation (ED, WIC or GP) were extracted from Cerner electronic medical records and CamKIT scores retrospectively calculated. Patients continued through the established referral pathway determined by the treating team; CamKIT scores did not influence clinical decisions. Patient outcomes were collected from clinic letters. Statistical analysis included sensitivity, specificity, PPV, NPV, descriptive statistics and Mann-Whitney U comparison between injured and non-injured cohorts using R(TM).
Results: 100 referrals were assessed; 20 were excluded due to lack of data or follow-up. 25 patients (29%) had confirmed STKI. CamKIT scores were significantly higher in injured (median 5; IQR: 4–6) than non-injured patients (median 2; IQR: 1–4) (p=0.0001). STKI rates rose with risk band: low 11% (5/47), moderate 48% (14/29), high 67% (6/9). Surgical consideration was given to 4% of low, 10% moderate and 44% of high risk groups. Sensitivity was 80%, specificity 70%, NPV 89% and PPV 53% overall.
Conclusion: CamKIT scores were significantly higher in patients with confirmed STKI. These findings support further evaluation of CamKIT as an ED-based triage tool to direct lower-risk knee injuries to physiotherapy or primary care, while reserving fracture clinic capacity for higher-risk referrals.
