CLINICAL-APPLICATION OF THE OTTAWA ANKLE RULES FOR THE USE OF RADIOGRAPHY IN ACUTE ANKLE INJURIES - AN INDEPENDENT SITE ASSESSMENT

OBJECTIVE. Previous studies show that the clinical criteria known as t he Ottawa ankle rules (OAR), used for determining the need for radiogr aphs of the ankle when a fracture is suspected, have a sensitivity of 100%, a specificity of 50%, and an overall reduction in radiographs of the ankle of 28%. The purpose of this study was to further assess the clinical usefulness of the OAR when implemented in an emergency depar tment of a level 1 trauma center. SUBJECTS AND METHODS. Over a 1-year period, all patients who were between 18 and 55 years old and who pres ented to the emergency department with blunt ankle trauma were examine d by emergency department clinicians who used the OAR to determine the need for ordering ankle radiographs. RESULTS. Of 926 patients with bl unt ankle trauma, 759 met OAR criteria for ordering radiographs of the ankle. Of these patients, 152 were found to have a fracture. Another 167 of the patients were determined not to need ankle radiographs. Thr ough either telephone contact or medical records review, 152 (91%) of these 167 patients were successfully followed up for the purpose of de tecting any missed fractures. Two missed fractures were discovered, bu t only one required plaster immobilization. Based on these numbers, ov erall sensitivity using the OAR was 99% (confidence interval, 95-100%) , and specificity was 22%. We found an overall 16% reduction in the nu mber of ankle films ordered. CONCLUSION. When implemented at a level 1 trauma center, the OAR can adequately screen for ankle fractures.