title: Utilization of the Ottawa ankle rules by nurses in a pediatric emergency department.
abstract: OBJECTIVE
  To determine the ability of pediatric emergency department (ED) nurses to accurately apply the Ottawa Ankle Rules (OAR) and to evaluate whether the rate of negative ankle radiographs can be reduced by incorporating the OAR into an existing collaborative practice protocol (CPP).
  
  
  METHODS
  The authors' ED currently uses a CPP in which patients with ankle pain, swelling, deformity, or decreased range of motion on primary nursing assessment undergo radiography prior to physician evaluation. A cross-sectional study was conducted between June and November 2000. Patients aged 5-19 years with an ankle injury who met at least one of the CPP criteria were eligible for enrollment. The OAR were applied by the primary nurse after initial assessment. Ankle radiographs were ordered for all enrolled patients. The interobserver variability between nurses was evaluated on a random sample.
  
  
  RESULTS
  One hundred ninety subjects were enrolled in the study. The OAR were correctly interpreted by nurses in 98.4% of subjects. Agreement on the interobserver reliability sample was 100%. Of the 185 subjects, 31 (16.8%) had positive radiographs. Positive OAR results were noted in 30 of 31 subjects with positive radiographs. The sensitivity of the OAR was 97% (95% CI = 0.82 to 0.99) with a specificity of 25% (95% CI = 0.18 to 032). Use of the OAR would have reduced the radiography rate by 21%.
  
  
  CONCLUSIONS
  Trained nurses can accurately apply and interpret the OAR. The incorporation of the OAR into the nursing assessment of children with acute ankle injuries may reduce the number of radiographs ordered.
authors.affiliation: Department of Pediatrics, Pediatric Emergency Medicine Section, Medical College of Wisconsin, Milwaukee, WI, USA. akarpas@mcw.edu
authors.forename: Anna
authors.initials: A
authors.lastname: Karpas
authors.forename: Halim
authors.initials: H
authors.lastname: Hennes
authors.forename: Christine M
authors.initials: CM
authors.lastname: Walsh-Kelly
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009730:Nursing Assessment; D015588:Observer Variation; D011859:Radiography / Q000592:standards / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity