Ottawa ankle rules for use in acute ankle injuries stiell et al. Multicentre trial to introduce the ottawa ankle rules for use of radiography in acute ankle injuries. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency. Objective the ottawa ankle rules will assist alberta clinicians assess if radiography of the foot. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments.
Before the introduction of the rules most patients with ankle injuries would have been imaged. The oar are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. Developed by scientists of the ottawa civic hospital stiell, greenberg et al. The ankle component of the oar states that radiographic evaluation of the ankle is only necessary if there is pain in the malleollar. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. Stiell is the principal investigator for 1 of 3 canadian sites in the. Awareness and use of the ottawa ankle and knee rules. Field trials will assess the feasibility of implementing these rules into clinical practice. All 2342 adults seen with acute ankle injuries during 5month periods before and after the. Ottawa ankle rules an overview sciencedirect topics. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot. Ottaaw ankle rules for ankle injury radiography stiell ig, mcknight rd, greenberg gh, et al.
Costeffectiveness analysis of the ottawa ankle rules. Ottawa ankle rules for the injured ankle british journal. To assess the impact on clinical practice of implementing the ottawa ankle rules. A posterior edge or tip of lateral malleolus c base of 5th metatarsal 6 cm b posterior edge or tip of medial malleolus d navicular malleolar zone lateral view medial view midfoot zone 6 cm. A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma. The derivation of a decision rule for the use of radiography in acute knee injuries. Pdf abstract ankle injury is a common injury sustained in an outdoor activity or as a sport injury presenting to the emergency department. Stiell ig, greenberg gh, wells ga, mcknight rd, cwinn aa, cacciotti t, mcdowell i, smith na.
Awareness and the use of the ottawa ankle and knee rules. The ottawa ankle rules, developed by stiell et al from ottawa, canada, are a set of guidelines designed to assist in the decision if a patient with foot or ankle pain should be offered xrays to diagnose a possible fracture. Ottawa criteria decision rules for determining who needs a knee ankle xray. In the united states, most ankle injuries are evaluated radiographically, 1,2 even though only about 15% are found to involve fractures. Evaluation of the ottawa clinical decision rules for the use of.
Refinement and validation have shown the ottawa ankle rules to be 100% sensitive for fractures, to be reliable, and to have the potential to allow physicians to safely reduce the number of radiographs ordered in patients with ankle injuries by one third. Conclusion ottawa ankle rule are very effective and can identify all clinically relevant fractures of ankle and foot with increased accuracy and sensitivity when applied by a trauma specialists. Stiell ig, wells ga, laupacis a, brison r, verbeek r, vandemheen k. The validation of this rule involved thousands of patients in a structured programme to generate rigorous. Limited data support its use by other health care workers in children.
Accuracy of the ottawa ankle rules applied by nonphysician. Knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. Since the rules were formulated in ottawa they were dubbed the ottawa ankle rules by their creators a few years after their development, a title that has stuck. Stiell received financial support from the institute of clinical and evaluative studies in ontario. Observational study to assess the potential of reducing the rate of. The ottawa ankle rules can significantly decrease the number of unnecessary ankle radiographs. Stiell ig, mcdowell i, nair rc, aeta h, greenberg g, mcknight rd, ah. Implementation of ottawa ankle rules health and social care essay. Ottawa ankle rules for the injured ankle british journal of. However the vast majority of patients with unclear ankle injuries do not have bone fractures. Stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla.
As a result, many unnecessary xrays were taken, which was costly, time consuming and a slight health risk due to radiati. The ottawa ankle rules were initially devised to include age greater than 55 years as a criterion for radiography. 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. Pdf application of ottawa ankle rules researchgate. Accuracy of ottawa ankle rules to exclude fractures of the. 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 rules. The rules use a standardized diagram of the foot and ankle, and two simple sets of discriminating rules, and include exclusionary. To summarise the evidence on accuracy of the ottawa ankle rules, a decision aid for excluding fractures of the ankle and midfoot. The ottawa knee rules determine the need for radiographs in acute knee injuries.
Stiell and others have developed a prediction rule for clinically significant injuries called the ottawa ankle rule. The ottawa ankle rules oar are a set of clinical decision rules that were derived and validated by stiell et al. Emergency departments of a university intervention hospital and a community control hospital. Ottowa knee rules okr stiell et al 1995 can ensure a consistent level of care for patients with. 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. Nonrandomized, controlled trial with beforeafter and concurrent controls. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use. In this podcast ian stiell discusses the rational use of clinical decision rules. Clinical usefulness of the ottawa ankle rules for detecting. The ottawa ankle rule project demonstrated that more than 95% of patients with. Radiography of the nkle and oot ottawa ankle rules clinical. Implementation of ottawa ankle rules health and social.
However, several limitations in the studies were cited. Data were extracted on the study population, the type of ottawa ankle rules used, and methods. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ottawa ankle rules for radiography of acute injuries. 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. Comparison of diagnostic decision rules and structured. Ottawa ankle rules the ottawa hospital research institute.
A multi centre trial of the implementation of the ottawa ankle rules which enrolled 12,777 patients showed a reduction of patients requiring a xray from 83% to 61% with a subsequent reduction in the time to discharge for the emergency department for those patients. A clinical decision rule to determine the need for diagnostic imaging for knee trauma. The ottawa ankle rules were developed and clinically tested to show that they led to a decrease in the use of ankle radiography, waiting times, and costs without patient. Implementation of clinical decision rules in the emergency. Pdf the ottawa ankle rules for the use of diagnostic x. We conclude that implementing ottawa ankle rule can identify all clinically relevant fractures of ankle and foot. This list of rules was published in 1992 by a team of doctors in the emergency department of the ottawa civic hospital in ottawa, canada. Stiell ig, mcdowell i, nair rc, aeta h, greenberg g, mcknight rd, ahuja j. In medicine, the ottawa ankle rules are a set of guidelines for clinicians to help decide if a. The ottawa ankle rules oar are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. Validation of the ottawa ankle rules in children with ankle injuries. Pdf the ottawa ankle rules for the use of diagnostic xray.
Validation of the ottawa ankle rules in children with ankle. Ottaaw ankle rules for ankle injury radiography a an ankle xray series is only required if there is. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. Implementation of the ottawa ankle rules jama network. Use of these rules reduced radiographic examinations by 28% for the ankle and 14% for the foot. Can we safely apply the ottawa ankle rules to children. Oct 01, 1995 the ottawa ankle rules have been shown to have extremely high sensitivity for prediction of fracture, and their adoption leads to reduced use of ankle radiography. Electronic databases, reference lists of included studies, and experts. Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa. R ankle and oot ottawa ankle rules summary of the clinical.
Decision rules for the use of radiography in acute ankle injuries. Principles of orthopaedic and trauma care ottawa ankle rules. Ottawa rules pdf 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 are a set of clinical decision rules developed by dr. Clinical value of the ottawa ankle rules for diagnosis of. Decision rules for the use of radiography in acute ankle. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of a patient usi. The ottawa ankle rules and missed fractures of the talus. The ottawa ankle rules determine the need for radiographs in acute ankle injuries. Ottawa ankle clinical decision instrument derivation study. Awareness and use of the ottawa ankle and knee rules in 5. A multicentre trial to introduce clinical decision rules for the use of radiography in acute ankle injuries.
Implementation of the ottawa ankle rules jama jama network. Ottawa ankle rules accurately assess injuries and reduce. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of an ankle and. Prospective validation of a decision rule for the use of radiography in acute knee injuries. Ottawa ankle rules do not apply to patients less than 5 years old or ankle injury greater than. Implementation of the ottawa ankle rules would therefore result in significant savings of health care dollars. The ottawa knee rules recommend knee xrays for any. Stiell, ian department of emergency medicine university. Faced with such inconsistent assessment and use of radiology, stiell and colleagues developed the concept of a clinical decision rule to guide the assessment of ankle injuriesin particular, to determine the indications for radiography. Stiell i, wells g, laupacis a, brison r, verbeek r, vandemheen k, naylor cd. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot.
The original derivation study by stiell et al was done. The ottawa ankle and foot rules to image or not to. The rules have been demonstrated to decrease unnecessary diagnostic imaging and emergency room wait times which enhances patient comfort and reduces health care costs. Less than a decade ago, clinical epidemiologist ian stiell, working with emergency department physicians, formulated the ottawa ankle rules. Ankle rules for ankle injury radiography stiell ig, mcknight rd, greenberg gh, et al. Ottawa rules pdf ottawa rules pdf ottawa rules pdf download. Marinelli validation of the ottawa ankle rules in m. Pdf abstract ankle injury is a common injury sustained in an outdoor activity. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the mid. A prospective study by stiell et al found the rules to be 100% sensitive for identifying. Get a printable copy pdf file of the complete article 915k, or click on a page. The ottawa ankle rules are simple guidelines developed to aid emergency physicians in deciding when to use radiography for patients with injuries to the ankle. Future studies should address the generalizability of these decision rules in a variety of hospital settings. A posterior edge or tip of lateral malleolus c base of 5th metatarsal 6 cm b posterior edge or tip of medial malleolus d navicular malleolar zone lateral view.
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