The ottawa ankle rules can be applied in children to determine the need for radiography in ankle and midfoot injuries. Ottawa ankle rules xray for acute injury of the ankle or. We use rules like the ottawa ankle rules all the time. It is based on the ottawa ankle rules which concern pain and tenderness in key areas of the limbs.
Implementation of the ottawa knee rule for the use of. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. The ottawa ankle rule is useful for ruling out fracture high sensitivity, but poor for ruling in fractures many false positives. In validation phase, the clinical decision rule was applied. Ankle rules 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. The ottawa rules have been validated by more than 20 studies, translated into several languages and adopted worldwide. 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.
Inability to bear weight immediately after injury and in the ed taking 4 steps or. Multicenter randomized controlled trial preceded and followed by observational studies of. The ottawa knee rules are useful in ruling out fracture high sensitivity when negative, but poor for ruling in fractures many false positives. Update on acute ankle sprains american family physician. Weightbearing inability was the ottawa ankle rule item that presented the highest reliability, 69. 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. Criteria ottawa knee rules xray for acute injury of the knee. This is in contradistinction to the ottawa ankle rule, in which a binary. The keywords ankle injury, clinical decision rule, paramedic, ambulance, prehospital, and emergency care were used to frame the search, while a prehospital and emergency care search filter was used to maximise the sensitivity of the search.
Diagnostic accuracy of the ottawa ankle and midfoot rules. Although the majority of ankle injuries are radiographed, fewer than 15 percent of these patients are found to have fractures of the ankle or foot. Ottawa ankle rules for the injured ankle useful clinical rules save on radiographs and need to be used widely w hat could possibly be more straightforward than the assessment of an injured ankle. Ottawa ankle rules ottawa health research institute. Derivation of a decision rule for the use of radiograph in acute.
Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. Before the introduction of the rules most patients with ankle injuries would have been imaged. The ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury. Ebscohost serves thousands of libraries with premium essays, articles and other content including use of the ottawa ankle rule by paramedics in the outofhospital setting. Pdf 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. Ankle sprains are a common occurrence in athletes as well as the general population. It looks at patients who have had a simple inversion or eversion injury and uses one historical feature. The ottawa ankle rules can aid decision making about whether a foot or ankle radiograph is needed in patients presenting with acute ankle injuries. Rigorous application of the oars have resulted in a 30% to 40% reduction in unnecessary xrays, while retaining nearly 100% sensitivity ottawa ankle rules, oar practice guidelines developed in canada in 1992 to reduce the number. Physicians placed greatest value on rulebased cues, while considering nonrulebased cues as moderately important. Patients with ankle injuries, usually sus tained recreationally or in a simple fall, attend emergency departments throughout the world in their. Ottowa rules definition of ottowa rules by medical dictionary. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments.
Knee rule for knee injury radiography a knee xray series is only required for knee injury patients with any of these findings. Jun 15, 2012 ankle sprains are a common problem seen by primary care physicians, especially among teenagers and young adults. The app includes the ottawa knee rule, the ottawa ankle rules and the canadian cspine rule, which were previously only available as posters or online. The primary outcome was the proportion of eligible patients referred for an ankle radiograph during the intervention and postintervention periods. Bone tenderness at the posterior edge or tip of the lateral malleolus a. Below the form you can read more about the rules and their interpretation. Avoids unnecessary diagnostics and xray exposure for the patient while cutting expenses for the system, leaving more resources for patients who actually need the care. Most places i have worked has a triage nurse who sees the patient first and applies the rule. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot in children. If you are interested in learning more about clinical decision rules, the ottawa ankle rule is a simple and world famous example, which was developed in ottawa and tested in many canadian centres including queens. An ankle xray series is only required if there is any pain in the malleolar zone and. Ottawa rules simplify the management of ankle injuries. Pdf validation of the ottawa ankle rules for acute foot. 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.
Understanding the role of the ottawa ankle rules in. This would allow a reduction in radiographs of the ankle of 16% and of the foot by 29%, without missing any clinically significant fracture. Diagnosis historically imaging is ordered for most patients presenting with an ankle andor midfoot injury even though only about 15%. 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. Use of the ottawa ankle rule by paramedics in the outof.
A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma. The ottawa ankle rules, developed by stiell, specifies the criteria to be met before ordering xrays for a patient presenting with an acute ankle injury. 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. Editor,further to previous correspondence i think the use of the ottawa ankle rule needs some clarification. Usethe ottawa ankle rules oar to exclude fractures and reduce unnecessary imaging. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging.
Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of an ankle andor foot injury using the ottawa ankle. Ottawa ankle rules xray for acute injury of the ankle or mid. There is room to improve physician agreement with the ankle rule and use of rulebased cues through knowledge translation interventions. However, the prehospital experience in implementing this clinical decision rule appears poorly described. Nonrandomized, controlled trial with beforeafter and concurrent controls. Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. Data sources medline, embase, cinahl, sportdiscus and cochrane library. Using the ottawa ankle rules, xray imaging can be reduced 34% for the ankle series and 30% for the foot series. Ottawa ankle rules definition of ottawa ankle rules by the. The objective of this study is to identify evidence of any level describing the use of the oar by. The ottawa knee rule is a validated clinical decision rule online pdf language converter for. Patients with osseous pain in the lower 6 cm of the fibula or tibia or inability to bear weight immediately after injury.
Usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. Eligibility criteria for selecting studies primary diagnostic studies reporting. Palpate the entire distal 6 cm of the fibula and tibia. Patients with osseous pain in the lower 6 cm of the fibula or tibia or inability to bear weight immediately after injury should have anteriorposterior, lateral and ankle mortise. In medicine, the ottawa ankle rules are a set of guidelines for clinicians to help decide if a. Ottawa ankle rules ottawa hospital research institute. The ottawa ankle rule project demonstrated that more than 95% of patients with. Implementation of the ottawa ankle rules jama network. This screening tool was developed because of the need for a rapid and accurate way to avoid unnecessary imaging. 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.
Future studies should address the generalizability of these decision rules in a variety of hospital settings. Ottawa ankle rule for the use of xray in ankle injury. Comparison of ottawa ankle rules and bernese ankle rules in. Ottawa ankle rules to exclude fractures of ankle and midfoot. However the vast majority of patients with unclear ankle injuries do not have bone fractures. The ottawa ankle rules determine the need for radiographs in acute ankle injuries. Do not neglect the importance of medial malleolar tenderness. However, only 1520% of patients have a clinically significant fracture. There was no increase in the number of missed fractures one in each group.
The ottawa ankle rules calculator rules out unnecessary xray imaging in the case of ordinary ankle and foot injuries in patients aged from 3 to 55 years old. Inability to bear weight immediately after injury and in the ed. Ottawa ankle rules an overview sciencedirect topics. Implementation of the ottawa ankle rules in france. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. Racgp the ottawa knee rules a useful clinical decision tool.
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. All 2342 adults seen with acute ankle injuries during 5month periods before and after the. A set of guidelines to help doctors decide if a patient with foot or ankle pain should be xrayed to rule out bone fracture. Ben yates, in clinical skills in treating the foot second edition, 2005. Most ankle sprains are inversion injuries to the lateral ankle ligaments, although. Oct 10, 2016 knowing when to order xrays, or even what to order, can be confusing. Ottawa ankle rules calculator this ottawa ankle rules calculator predicts the need for foot xray or ankle imaging in common injuries based on the accurate ottawa foot rules. 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. Derivation of a decision rule for the use of radiograph in acute knee injuries. Implementation of the ottawa ankle rules jama jama network. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of fracture diagnosis can lead to. Comparison of ottawa ankle rules and bernese ankle rules. The ottawa ankle rule oar is extensively documented in the emergency department setting and has been subjected to repeated validation.
The ottawa ankle rules were developed in order to determine the need for radiographs after acute ankle injury secondary to the risk of fracture. Racgp the ottawa knee rules a useful clinical decision. Ottowa rules definition of ottowa rules by medical. Get a printable copy pdf file of the complete article 915k, or click on a. Knowing when to order xrays, or even what to order, can be confusing. Emergency departments of a university intervention hospital and a community control hospital. Rigorous application of the oars have resulted in a 30% to 40% reduction in unnecessary xrays, while retaining nearly 100% sensitivity. 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. To assess the impact of the implementation of the ottawa ankle rules on radiography requests in french hospitals during a 5month intervention period and the impact of using posters alone to sustain the effect of the rules during a 5month postintervention period. Recreational and sporting injury to the adolescent knee and ankle. Ottawa ankle rules definition of ottawa ankle rules by. Ottawa ankle rules and subjective surgeon perception to evaluate. If patients were positive for any 1 of the 6 clinical variables listed in major points, an xray series was performed.
Ottawa ankle rules for radiography of ankle injuries. Ottawa ankle rules synonyms, ottawa ankle rules pronunciation, ottawa ankle rules translation, english dictionary definition of ottawa ankle rules. To assess the impact on clinical practice of implementing the ottawa ankle rules. Standard ankle series completed in patients with positive ottawa ankle rule, standard foot series completed in patients with positive ottawa foot rule. Tenderness of patella is significant only if an isolated finding. Any lowrisk factor which allows safe assessment of range of motion.
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