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Related Experiment Videos

Can nurses appropriately interpret the Ottawa Ankle Rule?

Frederick Fiesseler1, Paul Szucs, Robert Kec

  • 1Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey 07962, USA. fredf@garden.net

The American Journal of Emergency Medicine
|May 13, 2004
PubMed
Summary

Emergency department triage nurses demonstrated a moderate ability to interpret the Ottawa Ankle Rules (OAR), showing variable understanding of individual criteria for diagnosing ankle fractures. Further training may be needed to improve accuracy.

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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.

Related Experiment Videos

  • 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.