Purpose
The Ottawa Anke Rules (OAR) were developed as a clinical decision making tool that maximises sensitivity to rule out ankle or midfoot fractures [1],
and has the potential to substantially reduce unnecessary radiographic examinations.
The OAR are a clinical decision making tool that maximizes sensitivity to rule out ankle or midfoot fractures.
The ankle assessment covers the ability to walk four steps (immediately after the injury and in the ED) and notes localised tenderness of the posterior edge or tip of either malleolus (four spots)....
Methods and materials
A retrospective study was conducted where eligible patients were identified from the Alfred Health Picture Archiving and Communication System (PACS) and Radiology Information Services (RIS) database between a study period of 01 June 2015 to 30 October 2015.
There were a total of 908 ankle x-rays taken at the Alfred Hospital Emergency and Trauma Centre,
as well as the Sandringham Hospital Emergency Department.
Of the 908 cases screened,
404 met inclusion critiera.
Inclusion and exclusion criteria were as detailed as in Figure 1.
A retrospective...
Results
A total number of 394 patients were included in this study,
with 404 instances of ankle imaging.
The mean age was 38.5 years,
and approximately half (47.5%) of the patients were female.
In this study,
the overall prevalence of ankle fractures was 23.8%.
There was a reasonable compliance with the OAR with imaging,
with 87.6% of ankle imaging being compliant with the OAR indications.
25.9% of cases that had a positive score for the OAR had a positive or suspicious radiography for an ankle fracture...
Conclusion
Compliance with applying the Ottawa Ankle Rules
It is reassuring that this study revealed a high compliance rate (87.9%) with the OAR,
with 23.8% of ankle fractures detected on ankle radiography which is higher than reported rates of approximately 15% [4] in the literature.
This demonstrates that clinicians are open to new protocols and are able to use these tools effectively.
This proved especially useful in the larger of the emergency departments,
which is an Australian major trauma center where patient load is high and...
Personal information
Dr Chris-Tin Cheng is a 2nd year resident at the Alfred Hospital in Melbourne.
Dr Dinesh Varma is currently theActing Director of Radiology,
as well as theHead of Emergency & Trauma Radiology at the Alfred Hospital.
Dr DeVilliers Smit is the Director of the Emergency and Trauma Centre (E&TC) at the Alfred Hospital.
References
Stiell IG,
Greenberg GH,
McKnight RD,
Nair RC,
McDowell I,
Worthington JR.
A study to develop clinical decision rules for the use of radiography in acute ankle injuries.
Ann Emerg Med.
1992 Apr;21(4):384–90.
Holroyd BR,
Wilson D,
Rowe BH,
Mayes DC,
Noseworthy T.
Uptake of validated clinical practice guidelines: experience with implementing the Ottawa Ankle Rules.
Am J Emerg Med.
2004 May;22(3):149–55.
Cameron C,
Naylor CD.
No impact from active dissemination of the Ottawa Ankle Rules: further evidence of the need for local implementation of...