Use of the Ottawa ankle rules by nurse practitioners

To determine the ability of nurse practitioners to use the Ottawa ankle rules by comparing their requests for radiography with those of senior house officers (SHOs).

1365 patients were assessed by a nurse trained in the use of the Ottawa ankle rules. Where indicated the nurse sent the patient for radiography. 700 patients in the same period were seen by SHOs who had not received training in these rules. After three months the SHOs were similarly trained in the use of the rules and a further 700 patients were seen.

Nurse practitioners assessed 1365 patients; 72.6% had radiography. 1398 patients were seen only by an SHO. Before their use of the Ottawa ankle rules SHOs requested radiography in 91.0% (p = 0.001); using the rules this fell to 74.2% (p = 0.001).

Nurse practitioners trained to use the Ottawa ankle rules are as effective as SHOs in the implementation of the rules. Moreover the sensitivity and specificity of the Ottawa ankle rules was similar to that seen in other studies.