Congress:
EuroSafe Imaging 2016
Keywords:
Action 1 - Clinical decision support, clinical imaging guidelines, Action 1 - Guidelines, implementation policies, and Clinical Decision Support (ESR iGuide)
Authors:
G. Ivanac, E. Divjak, B. Brkljacic
DOI:
10.1594/esi2016/ESI-0023
Background/Introduction
The aim of this study is to raise the awareness of many unnecessary imaging procedures taken daily in our emergency department.
We focused on ankle series because ankle injuries are relatively common – according to Croatian health service yearbook for year 2014,
fractures of lower leg,
including ankle,
amount to 10% of all injuries registered in Croatian hospitals [1].
It is estimated that 80% to 98% of patients reporting to emergency rooms with injuries to the ankle,
midfoot or both undergo radiography during evaluation,
but fewer than 15% of these patients have a significant fracture [2].
This leads to additional health care costs,
causes prolonged stay at emergency department,
as well as unnecessary irradiation of the patient.
Ottawa ankle rules were introduced in 1992 by Still et al [3] to reduce costs and increase time effectiveness (eg,
decrease wait times) in the emergency department setting in terms of ruling out serious ankle and midfoot fractures in the nonathletic,
adult population.
According to Ottawa ankle rules,
radiography is recommended for patients who:
- were 55 years of age or older,
- were unable to bear weight for 4 steps both immediately and at the time of evaluation,
- experienced bone tenderness at the posterior edge (6 cm) or inferior tip of the lateral malleolus or at the posterior edge or inferior tip of the medial malleolus (Figure 1).
The rules have a high sensitivity (almost 100%) and modest specificity for significant ankle injuries [2],
and can reduce the number of ED radiographs of the ankle and foot by close to 30% [4,
5].
It is estimated that this can result in significant reduction of radiography cost [2].
It has been more than 20 years since Ottawa ankle rules were introduced,
and their efficacy has been firmly supported by scientific evidence.
However,
radiologists still encounter many unnecessary radiographic examinations and the rules aren’t fully implemented in everyday practice.
The authors tried to establish some of possible reasons.