Ottowa ankle rules order form unc school of medicine. We focused on studies in which the ottawa ankle rules was used to diagnose fractures of the ankle or midfoot. Patients with osseous pain in the lower 6 cm of the fibula or tibia or inability to bear weight immediately after injury should have anterior. Pdf abstract ankle injury is a common injury sustained in an outdoor activity or as a sport injury presenting to the emergency department. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the. Apr 09, 2014 the ottawa ankle and foot rule duration. A clinical decision rule to determine the need for diagnostic imaging for alert and stable trauma patients gcs 15 with neck pain. The ottawa ankle rules can significantly decrease the number of unnecessary ankle radiographs. The specificity of the ottawa ankle rules does not help rule in an ankle or foot fracture. The rules are intended to guide clinical decisions about the efficient use of radiography in the diagnosis of malleolar zone fractures and midfoot zone fractures, minimising expenditure. Less than a decade ago, clinical epidemiologist ian stiell, working with emergency department physicians, formulated the ottawa ankle rules. Ankle injuries are extremely common but many features on history and physical examination are unreliable the combined ottawa ankle and foot rules have a sensitivity of 97.
Clinical decision rules that allow physicians to be more selective in their use of radiography were compared with current practice in a decision analytic model. Less than 2% of patients in most subgroups who were negative for fracture according to the ottawa ankle rules actually had a fracture. Ottawa ankle rules for the injured ankle british journal of. Sensitivity and specificity of oar were 100% and 77% respectively. Comparison of ottawa ankle rules and bernese ankle rules. Use of the ottawa ankle rule by paramedics in the outof. Ottaaw knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. This screening tool was developed because of the need for a rapid and accurate way to avoid unnecessary imaging. It has been prospectively validated on multiple occasions in different populations and in both children and adults. The ottawa ankle rules are used as a clinical prediction rule to rule out an ankle fracture in an acute situation without the need for an xray. Ottawa ankle rules many trials evaluate the validity of the ottawa ankle rules oar for excluding fractures of the ankle in patients with an ankle sprain. Several studies have examined the effectiveness of the ottawa knee rules, with each reporting the rules leading to a decrease in the use of knee radiography. Validation of the ottawa ankle rules for acute foot and. The applicability of the ottawa ankle rules in children aged 216 years has been confirmed with 100% sensitivity for significant fractures of the ankle and midfoot.
The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. Eligibility criteria for selecting studies primary diagnostic studies reporting. Implementation of the ottawa ankle rules by emergency department physicians in the intervention hospitals using meetings, posters, pocket cards, and data forms. Ottawa ankle rules an overview sciencedirect topics.
The rules were also associated with a reduction in waiting times and costs. The ottawa ankle rules oar are a set of guidelines to help the physician as to decision making regarding need for x ray examination after ankle and midfoot injury. Palpate the entire distal 6 cm of the fibula and tibia. The ottawa knee rules are a set of rules used to help physicians determine whether an xray of the knee is needed they state that an xray is required only in patients who have an acute knee injury with one or more of the following. Feb 22, 2003 we summarised the accuracy of the ottawa ankle rules for excluding fractures of the ankle and midfoot in patients presenting to emergency departments with an acute ankle sprain. This became known as the ottawa ankle rules, using bony tenderness and inability to. There are three sets of rules, one each for the foot, ankle and knee. The ottawa ankle rules ankle fracture clinical prediction rule duration. Yes no for patients with acute trauma to the ankle bone tenderness at a bone tenderness at b inability to bear weight both immediately and in the ed an ankle radiographic series is only required if there is any pain in the malleolar zone and any of these. The ottawa ankle rules oar are a set of clinical decision rules that were derived and validated by stiell et al.
Safety and efficiency of the ottawa ankle rule in a swiss population. Implementation of the ottawa ankle rules jama jama network. A decision analytic approach to technology assessment. Ottawa ankle rules accurately assess injuries and reduce. Awareness and use of the ottawa ankle and knee rules in 5 countries. The ottawa knee rule describes criteria for minor knee trauma patients that are so low risk as not to warrant knee imaging. You know that the ottawa ankle rules are applicable in adult patients and you. Bone tenderness at the posterior edge or tip of the lateral malleolus a. Imaging is required if there is pain in the midfoot zone and any of the following. Implementation of the ottawa ankle rules led to a decrease in use of ankle radiography, waiting times, and costs without patient dissatisfaction or missed fractures.
Ottawa ankle rules for ankle injury radiography an ankle xray series is only required if there is any pain in the malleolar zone and any of these findings. Ottawa ankle rules for the injured ankle british journal. Using the ottawa ankle rules, xray imaging can be reduced 34% for the ankle series and 30% for the foot series. Ottawa ankle rule oar to rule out ankle and midfoot fractures in patients presenting with acute ankle sprain and. The ottawa ankle rules and missed fractures of the talus. Eligibility criteria for selecting studies primary diagnostic studies. We electronically searched databases, checked the reference lists of included studies, and contacted experts and authors in the specialty see appendix on. Costeffectiveness analysis of the ottawa ankle rules. Yes no for patients with acute trauma to the ankle. The oar are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. Ottawa knee rule ottawa hospital research institute. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. During the postintervention period, posters alone were used to sustain the intervention effect.
Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. Before the introduction of the rules most patients with ankle injuries would have been imaged. Pdf comparison of ottawa ankle rules and bernese ankle. Comparison of ottawa ankle rules and bernese ankle rules in acute ankle and midfoot injuries article pdf available in turkish journal of emergency medicine 10 january 2010 with 2,929 reads. Comparison of ottawa ankle rules and bernese ankle rules in acute ankle and midfoot injuries injury during daily walking, and the remaining reported other reasons. Racgp the ottawa knee rules a useful clinical decision. The ottawa ankle rule is useful in ruling out fracture high sensitivity, but does poorly at ruling in fractures many false positives. The ottawa ankle rules oar are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. Key recommendations usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. The ankle component of the oar states that radiographic evaluation of the ankle is only necessary if there is pain in the malleollar zone and one of the.
Update on acute ankle sprains american family physician. The ottawa ankle rules determine the need for radiographs in acute ankle injuries. It is anticipated that application of the ottawa ankle rules in preschool children is difficult as the rules rely on their ability to report tenderness. Discuss the history, exam findings, and ottawa rules with patients. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. Validation of the ottawa ankle rules for acute foot and ankle injuries in journal of. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot.
A clinical decision rule to determine the need for diagnostic imaging for knee trauma. Rule out a complete tear of the ligaments by doing drawer testing of the ankle before discharging the patient or at the first followup visit ottawa knee rules a knee xray is only required for knee injury patients with any of these findings. The most important step in ankle fracture management is identifying stable verses unstable fractures. While all of these rules can be used in patients under the age of 18, they should be used with caution. Ottawa ankle rule in the evaluation for fractures in blunt. A previous best evidence topic report examined whether these rules could be applied to children. An ankle xray series is only required if there is any pain in the malleolar zone and. The ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury. An ankle xray series is only required if there is any pain in the malleolar zone and any of these findings. The rules appear on the front page of this document. The ottawa ankle rules should be used to rule out fractures and prevent unnecessary radiography in patients with suspected ankle sprain. Ottaaw ankle rules for ankle injury radiography stiell ig, mcknight rd, greenberg gh, et al. If a patient does not exhibit any of the criteria of the ottawa ankle rules, radiographs of the foot or ankle are unnecessary sor. The ottawa ankle rules in children emergency medicine.
It is the dedication of healthcare workers that will lead us through this crisis. This would allow a reduction in radiographs of the ankle of 16% and of the foot by 29%, without missing any clinically significant fracture. Multi trial to introduce the ottawa ankle rule for the use of radiography in acute ankle injuries the fifth study assessed the feasibility and impact of. Ottawa ankle rules ottawa hospital research institute. Multi trial to introduce the ottawa ankle rule for the use of radiography in acute ankle injuries the fifth study assessed the feasibility and impact of introducing the ottawa ankle rules in a wide variety. The ottawa ankle rules modified buffalo rule the buffalo rule was derived to increase the diagnostic accuracy of the ottawa ankle rules, with the point tenderness criterion directed to the crest or midportion of the malleoli distal 6 cm of the fibula and tibia, reducing the likelihood of palpating over injured ligament structures.
The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot. The ottawa ankle rules and the buffalo modification of the ottawa rules should be judiciously applied to adult patients with ankle trauma to decrease the total number of ankle radiographs obtained. The metaanalysis of bachmann, with a moderate risk of bias, summarizes the accuracy of the oar from 1990 to 2002. Jun 15, 2012 clinical recommendation evidence rating references. They are also careful to point out several groups in whom they do not feel the rules should be applied, such as the intoxicated, the multiply injured, or. Use of the ottawa ankle rule by paramedics in the outofhospital setting introduction the ottawa ankle rule oar is extensively documented in the emergency department setting and has been subjected to repeated validation. Comparison of ottawa ankle rules and bernese ankle rules in. In the united states, most ankle injuries are evaluated radiographically, 1,2 even though only about 15% are found to involve fractures. Report by mancheuk yuen, senior medical officer checked by fiona saunders, specialist registrar a 5 year old boy attends the emergency department after sustaining a twisting injury to his left ankle. Because ankle injuries are one of the most common orthopedic injuries and the validity of these clinical decision rules is well established, the acha benchmarking committee selected adherence to the ottawa ankle and foot rules in assessing patients with ankle injuries as an evidencebased acute care benchmark. In medicine, the ottawa ankle rules are a set of guidelines for clinicians to help decide if a patient with foot or ankle pain should be offered xrays to diagnose a possible bone fracture. The ottawa ankle rule can be used in the evaluation of ankle injuries to identify patients who have a low likelihood of fracture.
This obviates the need for obtaining ankle radiographs in certain patients, reducing cost, resource utilization, radiation exposure, and potentially, emergency department length of stay. Accuracy of ottawa ankle rules to exclude fractures of the. Editor,further to previous correspondence i think the use of the ottawa ankle rule needs some clarification. Pdf application of ottawa ankle rules researchgate. The ottawa ankle rules were developed to identify those subjects with an ankle sprain who required radiographs to rule out the presence of subtle or frank fracture. The ottawa ankle rules have a high sensitivity for. The ottawa ankle rule was derived to aid in the efficient use of radiography in acute ankle and midfoot injuries. Diagnostic accuracy of the ottawa ankle and midfoot rules.
On examination there is swelling and tenderness over the lateral malleolus. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. The oars were applied to all appropriate ankle injuries at 2 colleges athletics and club sports and 21 high schools. Data sources medline, embase, cinahl, sportdiscus and cochrane library. The ottawa ankle rule project demonstrated that more than 95% of patients with ankle injuries had radiographic examinations but that 85% of the films showed no fractures. An ankle xray is required only if there is any pain in malleolar zone and any of these findings. Since the publication of this study, the ottawa ankle rule have been well validated and have been shown to limit the number of radiographs obtained for ankle injuries, decreased patient wait times and cost. Sensitivities for the ottawa ankle rule range from the high 90% to 100% range for clinically. Future studies should address the generalizability of these decision rules in a variety of. A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma. However, the number of preschool children included in all these studies was small. The ottawa ankle rules in children emergency medicine journal. Prospective validation of a decision rule for the use of radiography in acute knee injuries.
To conduct an incremental costeffectiveness analysis of implementation of the ottawa ankle rules in emergency departments in the united states and canada. Are the ottawa ankle rules helpful in ruling out the need. For ankle injury radiography a an ankle xray series is only required if there is any pain in malleolar zone and any of these findings. Sep 06, 2018 there are three sets of rules, one each for the foot, ankle and knee.
464 779 171 391 136 1322 1196 154 476 166 1445 877 109 942 1536 1299 1269 835 1321 749 870 235 50 177 943 340 907 955 1341 1048 92 1289 1347 793 619 1214