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