Clinical application of the Ottawa ankle rules for the use of radiography in acute ankle injuries: an independent site assessment.
OBJECTIVE
Previous studies show that the clinical criteria known as the Ottawa ankle rules (OAR), used for determining the need for radiographs of the ankle when a fracture is suspected, have a sensitivity of 100%, a specificity of 50%, and an overall reduction in radiographs of the ankle of 28%. The purpose of this study was to further assess the clinical usefulness of the OAR when implemented in an emergency department of a level 1 trauma center.


METHODS
Over a 1-year period, all patients who were between 18 and 55 years old and who presented to the emergency department with blunt ankle trauma were examined by emergency department clinicians who used the OAR to determine the need for ordering ankle radiographs.


RESULTS
Of 926 patients with blunt ankle trauma, 759 met OAR criteria for ordering radiographs of the ankle. Of these patients, 152 were found to have a fracture. Another 167 of the patients were determined not to need ankle radiographs. Through either telephone contact or medical records review. 152 (91%) of these 167 patients were successfully followed up for the purpose of detecting any missed fractures. Two missed fractures were discovered, but only one required plaster immobilization. Based on these numbers, overall sensitivity using the OAR was 99% (confidence interval, 95-100%), and specificity was 22%. We found an overall 16% reduction in the number of ankle films ordered.


CONCLUSIONS
When implemented at a level 1 trauma center, the OAR can adequately screen for ankle fractures.
Verma
S
S
Department of Radiology, University of Cincinnati College of Medicine, OH 45267, USA.
Hamilton
K
K
Hawkins
H H
HH
Kothari
R
R
Singal
B
B
Buncher
R
R
Nguyen
P
P
O'Neill
M
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*