EBQ:Ottawa Ankle Rule Study: Difference between revisions

Revision as of 02:39, 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

Exclusion Criteria

Interventions

Outcomes

Primary Outcome

Secondary Outcomes

Subgroup analysis

Criticisms & Further Discussion

Funding

Sources

Authors:

@@ Line 20: / Line 20: @@
 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===
+[[File:anklexray.jpg|thumbnail]]
+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===
+[[File:footxrays.jpg|thumbnail]]
+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==