Ottawa versus Bernese: which is better?

Area of Science:

• Emergency Medicine
• Radiography
• Orthopedic Trauma

Background:

• Foot and ankle trauma frequently presents to emergency services.
• Radiography is often necessary to rule out fractures in these patients.
• Clinical decision rules can aid in guiding radiographic imaging.

Purpose of the Study:

• To evaluate the diagnostic accuracy of the Ottawa ankle rules and the Bernese ankle rules.
• To compare the sensitivity and specificity of these two clinical decision rules in a prospective study.
• To assess their utility in managing patients with acute foot and ankle injuries.

Main Methods:

• A prospective, randomized clinical study involving 962 adult patients with recent foot and ankle trauma.
• Physicians trained in the Ottawa ankle rules and Bernese ankle rules evaluated patients.
• All patients underwent standardized ankle and foot radiography, irrespective of rule application.
• Sensitivity, specificity, and false-negative/positive ratios were calculated for both rule sets.

Main Results:

• The Ottawa ankle rules demonstrated a sensitivity of 74.8% and specificity of 68.6%.
• The Bernese ankle rules showed a sensitivity of 55.7% and specificity of 79%.
• The Ottawa ankle rules had a lower false-negative ratio (15.1%) compared to the Bernese ankle rules (21.4%).

Conclusions:

• The Ottawa ankle rules are more sensitive than the Bernese ankle rules for identifying foot and ankle fractures.
• Neither rule set achieved 100% reliability, indicating potential for missed fractures.
• Clinical judgment alongside these rules is crucial for accurate diagnosis in emergency settings.