title: Validation of the Ottawa ankle rules in children.
abstract: OBJECTIVE
  To assess whether the Ottawa ankle rules can be used to accurately predict which children with ankle and midfoot injuries need radiography.
  
  
  METHODS
  Prospective study with historical control group of all children aged 1-15 years presenting to Sheffield Children's Hospital accident and emergency department with blunt ankle and/or midfoot injuries during two five month periods before and after implementation of the Ottawa ankle rules.
  
  
  RESULTS
  In the study group 432 out of 761 (56.76%) patients received radiography compared with 500 out of 782 (63.93%) in the control group. This was a statistically significant reduction in radiography rate of 7.2% (95% confidence interval 2.3% to 12.1%, p <0.01). The sensitivity of the Ottawa ankle rules was 98.3% and the specificity 46.9%. There was no increase in the number of missed fractures (one in each group).
  
  
  CONCLUSIONS
  The Ottawa ankle rules can be applied in children to determine the need for radiography in ankle and midfoot injuries. Their implementation leads to a reduction in the radiography rate without leading to an increase in the number of missed fractures.
authors.affiliation: Accident and Emergency Department, Northern General Hospital, Sheffield.
authors.forename: C
authors.initials: C
authors.lastname: Libetta
authors.forename: D
authors.initials: D
authors.lastname: Burke
authors.forename: P
authors.initials: P
authors.lastname: Brennan
authors.forename: J
authors.initials: J
authors.lastname: Yassa
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016512:Ankle Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004638:Emergency Treatment / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D018409:Foot Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education; D010146:Pain / Q000209:etiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging*