title: Nurse practitioners treating ankle and foot injuries using the Ottawa Ankle Rules: a comparative study in the emergency department.
abstract: BACKGROUND
  Nurse practitioners (NPs) in the Emergency Department (ED) have been trained to assess a range of clinical problems and minor complaints such as acute ankle injury. This study compared assessment of suspected ankle and foot injuries using the Ottawa Ankle Rules (OAR) by NPs and ED medical doctors (ED-Drs).
  
  
  METHODS
  A prospective, comparative, observational study was undertaken in an Australian acute adult and paediatric urban district ED. NPs and ED-Drs recorded information for patients with acute ankle and/or mid-foot injuries on demographic characteristics, OAR features, use of X-ray and patient management. Outcome measures included X-ray rates and identification of fracture.
  
  
  RESULTS
  174 patients were included in this study: 51 received NP and 123 received ED-Dr care. Assessed as requiring X-ray assessment (NP: 78.4%, ED-Dr: 88.6%; p=0.081), and detection of significant fracture (NP: 17.6%, ED-Dr: 22.8%; p=0.453) were similar. ED-based medical registrars were more likely to miss a fracture compared with NP (NP: 0%, ED-based Registrar: 28.6%, p=0.013). There were no significant differences in rates of OAR features for patients seen by NPs or ED-Drs.
  
  
  CONCLUSIONS
  This study suggests that NPs are less likely to miss significant fractures of the ankle and/or foot compared with ED-based medical registrars. Future research should focus on actual use of the OAR and accuracy of X-ray assessment by NPs.
authors: University of Melbourne, Parkville, Australia.
authors: Lik Hui
authors: LH
authors: Lau
authors: Debra
authors: D
authors: Kerr
authors: Ian
authors: I
authors: Law
authors: Peter
authors: P
authors: Ritchie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064386:Ankle Fractures; D016512:Ankle Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000451:nursing; D002648:Child; D002675:Child, Preschool; D005188:False Negative Reactions; D005260:Female; D018409:Foot Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000451:nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Ankle; Emergencies; Nurse practitioner; X-rays