Prospective survey to verify the Ottawa ankle rules

Area of Science:

• Emergency Medicine
• Diagnostic Accuracy
• Clinical Decision Rules

Background:

• The Ottawa ankle rules are widely used to guide radiography for acute ankle injuries.
• Validation in diverse clinical settings, including UK urban teaching hospitals, is essential.

Purpose of the Study:

• To assess the validity and sensitivity of the Ottawa ankle rules in a UK urban teaching hospital setting.
• To evaluate the rules' effectiveness in reducing unnecessary radiography for ankle injuries.

Main Methods:

• Prospective survey conducted in an Accident and Emergency department.
• Inclusion of 800 patients presenting with acute ankle injuries.
• Analysis of fracture detection rates based on adherence to the Ottawa ankle rules criteria.

Main Results:

• Of 800 patients, 584 (73%) underwent radiography, revealing 70 (12%) fractures.
• Significant fractures were identified in 63 patients (10.8%).
• Four patients with fractures did not meet the Ottawa ankle rules criteria for radiography, indicating a potential missed diagnosis if rules were strictly followed without clinical judgment.

Conclusions:

• The Ottawa ankle rules achieved a sensitivity of 93.6% in this cohort.
• The rules are a useful adjunct but should not supersede clinical judgment and experience in managing acute ankle injuries.
• Careful application is advised to optimize diagnostic accuracy and patient care.