A POOLED ANALYSIS OF THE OTTAWA ANKLE RULES USED ON ADULTS IN THE ED

A pooled analysis was conducted of the seven studies on the clinical d iagnostic effectiveness of the Ottawa ankle rules when used with adult patients in the emergency department (ED). The seven studies, conduct ed in university and community hospital EDs, had examined the sensitiv ity, specificity, and positive and negative predictive values of the O ttawa ankle rules. ED physicians applied the Ottawa ankle rules with a dult patients who had blunt ankle injuries. The gold standard was radi ography, The combined sensitivity for the seven studies was 97% or hig her for ankle/foot, original/refined Ottawa ankle rules and negative p redictive value was greater than 99%. These results support the effect iveness of the Ottawa ankle rules for ruling out a fractured ankle or foot. Specificity was lower, ranging from 31% to 63%; positive predict ive value was <20%. Thus, the Ottawa ankle rules should not be used fo r ruling in a fractured ankle or foot. This pooled analysis shows the Ottawa ankle rules to he effective as clinical practice guidelines for acute ankle and foot injuries in the adult ED patient. Patients with negative results when the rules are used are highly unlikely to have a fractured ankle or foot, but the diagnosis for positive patients is m uch less certain, suggesting the need for radiography. (Am J Emerg Med 1998;16:564-567, Copyright (C) 1998 by W.B. Saunders Company).