The impact of ankle radiographs on the diagnosis and management of acute ankle injuries.
OBJECTIVE
We assessed the impact of ankle radiographs on referring physicians' diagnoses and treatment of acute ankle injuries.


METHODS
Twenty emergency department physicians prospectively completed questionnaires before and after radiography on 101 patients with acute trauma receiving ankle radiographs. The questionnaires asked physicians to estimate the probability (0-100%) of their most likely diagnosis before and after receiving the radiographic information. We also asked their anticipated and final treatment plans. We calculated the mean gain in diagnostic confidence percentage and the proportion of patients with changed initial diagnoses or anticipated management.


RESULTS
The mean gain in diagnostic certainty from ankle radiographs was 34% (95% confidence interval [CI] = 28-40%). Ankle radiographs changed physicians' initial diagnoses in 37% (95% CI = 28-47%) of the patients. Immediate clinical management changed in 30% (95% CI = 22-40%) of the patients.


CONCLUSIONS
Plain ankle radiographs have considerable impact on referring physicians' diagnoses and treatment of acute ankle trauma.
Omary
R A
RA
Department of Radiology, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Kaplan
P A
PA
Dussault
R G
RG
Hornsby
P P
PP
Carter
C T
CT
Kahler
D M
DM
Hillman
B J
BJ
D000208:Acute Disease; D000842:Ankle / Q000000981:diagnostic imaging*; D016512:Ankle Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy; D000843:Ankle Joint / Q000000981:diagnostic imaging*; D003657:Decision Making; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006801:Humans; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries; D010347:Patient Care Planning; D011336:Probability; D011446:Prospective Studies; D011859:Radiography; D012017:Referral and Consultation; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries