Implementation of the Ottawa Ankle Rules by nurses working in an accident and emergency department

To assess whether accident and emergency (A&E) nurses using the Ottawa Ankle Rules could detect all ankle fractures.

Prospective observational study.

A&E department of a university teaching hospital.

All patients who presented with ankle injuries who were initially assessed by a nurse taught the Ottawa Ankle Rules.

(1) The numbers of patients referred by the nurse for ankle radiography; (2) of these, the number with ankle fractures; (3) of those not sent for radiography initially by the nurse, the number who subsequently had x rays (ordered by the doctor) and had a fracture; (4) of those having no x rays, the number who reattended later.

324 patients were eligible; 238 had x rays at the request of the nurse (73%); 48 of these (20%) were diagnosed as having a fracture. Of those 86 patients not sent for radiography by the nurse, 19 subsequently had x ray examinations at the request of a doctor and no fracture was detected. Of the 67 not sent for radiography, none returned within the subsequent eight weeks.

Nurses can apply the Ottawa Ankle Rules safely without missing acute fractures; that is, of those who were not sent for radiography by nurses, none subsequently reattended the A&E department or the trauma service of the Bristol Royal Infirmary during the following two months.