EBQ:Ottawa Ankle Rule Study

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.
PubMed Full text PDF

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.

Population

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

Funding

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