EBQ:Ottawa Ankle Rule Study: Difference between revisions

Revision as of 02:57, 1 September 2015

incomplete Journal Club Article

Stiell I. et al.. "Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation.". JAMA. 1993. 269(9):1127-32.
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Clinical Question

Can a clinical decision rule be used to aid in the efficient use of radiography in acute ankle injuries?

Conclusion

The Ottawa Ankle Rule is a highly sensitive decision rule used to determine the need for radiography in patients with acute ankle injuries.

Major Points

Ankle Rules

Ankle x-ray needed if pain near the maleoli AND

Inability to bear weight immediately and in the ED (4 steps)

OR

Tenderness at posterior edge or tip of lateral malleolus

OR

Tenderness at posterior edge or tip of medial malleolus

Rule had 100% sensitivity and 49% specificity for identifying 50 clinically significant malleolar zone fractures in the prospective validation study.

Foot Rules

Foot x-ray series needed if pain in the midfoot AND

Inability to bear weight both immediately and in the ED (4 steps)

OR

Tenderness at the navicular

OR

Tenderness at the base of the 5th metatarsal

Rule had 100% sensitivity and and 79% specificity for identifying 19 clinically significant midfoot fractures in the prospective validation study.

Study Design

Population

Patient Demographics

Inclusion Criteria

Patients who presented to the emergency department with pain or tenderness 2/2 to blunt ankle trauma due to any mechanism of trauma
Ankle defined as area commonly involved in twisting injuries
- Malleolar zone
  - Distal 6 cm of tibia, fibula, talus
- Midfoot zone
  - Navicular bone, cuboid, cuneiforms, anterior process of calcaneus, base of 5th metatarsal
1 of 21 designated EM physicians had to be on duty

Exclusion Criteria

Age <18 years old
Pregnant
Isolated injuries of the skin
Referred from outside hospital with radiographs
Injury occurred >10 days previously
Returned for reassessment of the same injury

Interventions

Outcomes

Primary Outcome

Secondary Outcomes

Subgroup analysis

Criticisms & Further Discussion

Funding

Grant from Emergency Health Services Branch of Ontario Ministry of Health, Toronto

Sources

Authors:

@@ Line 52: / Line 52: @@
 ===Patient Demographics===
 ===Inclusion Criteria===
+*Patients who presented to the emergency department with pain or tenderness 2/2 to blunt ankle trauma due to any mechanism of trauma
+*Ankle defined as area commonly involved in twisting injuries
+**Malleolar zone
+***Distal 6 cm of tibia, fibula, talus
+**Midfoot zone
+***Navicular bone, cuboid, cuneiforms, anterior process of calcaneus, base of 5th metatarsal
+*1 of 21 designated EM physicians had to be on duty
 ===Exclusion Criteria===