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Related Experiment Videos

Implementation of the Ottawa ankle rules

I G Stiell1, R D McKnight, G H Greenberg

  • 1Division of Emergency Medicine, University of Ottawa, Faculty of Medicine, Ontario, Canada.

JAMA
|March 16, 1994
PubMed
Summary
This summary is machine-generated.

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Implementing the Ottawa ankle rules significantly reduced ankle and foot radiography use, waiting times, and costs in emergency departments. This clinical practice change did not compromise patient satisfaction or miss fractures.

Area of Science:

  • Emergency Medicine
  • Radiology
  • Clinical Decision Support

Background:

  • Acute ankle injuries are common in emergency departments.
  • Radiographic imaging is frequently overutilized for ankle injuries.
  • The Ottawa ankle rules were developed to guide the need for radiography.

Purpose of the Study:

  • To evaluate the impact of implementing the Ottawa ankle rules on clinical practice.
  • To assess changes in radiography use, patient waiting times, and costs.

Main Methods:

  • A nonrandomized, controlled trial was conducted in university and community hospital emergency departments.
  • The study involved 2342 adult patients with acute ankle injuries over 5-month periods before and after intervention.
  • The intervention involved the implementation of the Ottawa ankle rules by physicians.

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Main Results:

  • Ankle radiography decreased by 28% and foot radiography by 14% at the intervention hospital, with opposite trends in the control hospital.
  • Patients without radiography spent less time in the ED (80 vs 116 minutes) and incurred lower costs ($62 vs $173).
  • The Ottawa ankle rules demonstrated high sensitivity (1.0) for detecting malleolar and midfoot fractures, with no increase in subsequent radiography use.

Conclusions:

  • Implementation of the Ottawa ankle rules effectively reduced radiography use, waiting times, and costs.
  • The decision rules maintained high sensitivity for fracture detection without impacting patient satisfaction.
  • Further research is recommended to explore the generalizability of these rules across diverse healthcare settings.