Can nurses appropriately interpret the Ottawa Ankle Rule?

Area of Science:

• Emergency Medicine
• Clinical Decision Rules
• Diagnostic Accuracy

Background:

• The Ottawa Ankle Rules (OAR) are a validated clinical decision tool to guide X-ray use in acute ankle injuries.
• Accurate interpretation of the OAR by healthcare professionals is crucial for appropriate patient management and resource utilization.

Purpose of the Study:

• To evaluate the ability of emergency department (ED) triage nurses to accurately interpret the Ottawa Ankle Rules (OAR).
• To assess the interobserver agreement between nurses and emergency physicians (EPs) in applying the OAR.

Main Methods:

• A prospective, observational trial was conducted in a suburban ED involving patients over 17 with acute ankle injuries.
• Nurses and EPs were trained on the OAR and completed standardized, blinded assessments.
• Sensitivity, specificity, and interobserver agreement (kappa values) were calculated for nurse and EP interpretations.

Main Results:

• Interobserver agreement between nurses and EPs for overall OAR interpretation was moderate (kappa = 0.44).
• Nurse sensitivity for fracture detection was 92% with 36% specificity; EP sensitivity was 92% with 47% specificity.
• Agreement on individual OAR criteria varied from moderate to fair, indicating inconsistent understanding.

Conclusions:

• ED triage nurses possess a moderate capacity to interpret the OAR for guiding X-ray decisions in acute ankle injuries.
• Variable understanding of specific OAR criteria among nurses suggests a need for enhanced training and protocol refinement.