Ankle injury is a common presentation to the Emergency Department, accounting for a significant proportion of Emergency Department (ED) reporting work. Radiological diagnosis is heavily reliant on the quality & adequacy of radiographs. This is important because suboptimal ankle radiographs can lead to false diagnosis and consequently incorrect management. In patients who have sustained trauma, lateral and AP (mortise view) ankle radiographs are generally performed in the UK. ICE is an online investigation requesting platform. Aim: To evaluate appropriateness of referrals for ankle radiography in...

• Find 100 referrals from ED using the list of patients who underwent ankle trauma • Find requests on ICE to assess clinical information provided by ED clinicians • Look through ED notes to find the percentage providing adequate clinical information with reference to the OAR • Data collection into Excel • Repeat process for cycle 2 after the intevention Standards and guidelines • An ankle x-ray series is only required if there is pain in the malleolar zone AND any of these findings: •...

Out of 100 referrals: • 52% from cycle 2 (44% from cycle 1) were male; 48% (56% from cycle 1) were female • 45% (52%) were left ankle injuries; 55% (48%) were right ankle injuries • 14% (16%) actually sustained fractures • In cycle 1 (figure 1), 12 ankle radiograph requests were not justified; 9/12 showed no fractures, 2/12 breached the 4-hour waiting time. • In cycle 2 (figure 2), all requests were justified (figure 3) - none breached the 4-hour waiting time After the...

• The target of 100% compliance with the referral guidelines was met after the intervention of electronic display of the Ottawa Ankle Rules on the investigation request service. Significance of intervention: • No patients underwent unnecessary ankle radiographs • Reduction in unnecessary radiation exposure • Reduced waiting times and costs • Reduction in long term hazards to children due to being more vulnerable to the effects of radiation

• Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G (February 2003). "Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review". BMJ 326 (7386): 417. • Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and midfoot in children: A meta-analysis. Acad Emerg Med 2009;16(4):277-287 • Royal College of Radiologists. “A guide to understanding the implications of the Ionising Radiation (Medical Exposure) Regulations in diagnostic and interventional...

R. Akram: Nothing to disclose D. Fidler: Nothing to disclose E. White: Nothing to disclose