Can We Safely Apply the Ottawa Ankle Rules to Children?

Runyon, Michael S.

doi:10.1111/j.1553-2712.2009.00370.x

Cited by 9 publications

(4 citation statements)

References 13 publications

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“…5 years of age with blunt trauma to the ankle or midfoot. 16 Our study indicates that the majority of Canadian PEPs use the OAR when evaluating ankle and foot injuries. Those who used the rules were more likely to have recently completed a residency program and not be primary PEPs.…”

Section: Discussionmentioning

confidence: 65%

Use of the Ottawa Ankle Rules in children: a survey of physicians’ practice patterns

Dowling

Wishart

2011

CJEM

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Introduction: A number of studies have assessed the diagnostic accuracy of the Ottawa Ankle Rules (OAR) in children; however, the role of the OAR in guiding physician radiograph use is unclear. Objectives: The primary purpose of this study was to determine the extent to which Canadian pediatric emergency physicians report using the OAR. Secondary goals included determining current diagnostic and management strategies for Salter-Harris 1 (SH-1) injuries of the ankle and which fractures physicians deem to be clinically significant. Methods: A self-administered piloted survey was distributed by mail to 215 Canadian pediatric emergency physicians using a modified Dillman technique. Participants were selected through Pediatric Emergency Research Canada (PERC), a national network of health care professionals with an interest in pediatric emergency medicine research. Results: Of 209 surveys, 144 were returned, for a response rate of 68.9%. Of those, 87.5% (126 of 144) reported applying the OAR in children to determine the need for radiographs in acute ankle or midfoot injuries. Of those, 65.1% reported using the OAR always or usually, and 64.5% (93 of 144) of physicians stated that they believe all ankle fractures are clinically significant. Although physicians report that they most commonly order the radiographs, 36.2% of participants indicated that radiographs were requisitioned by nurses or other health care providers at their facilities. SH-1 fractures were reported to be most commonly managed by immobilization (83.3%; 120 of 144), with most patients going on to follow-up with an orthopedic surgeon. Conclusions: The majority of Canadian pediatric emergency physicians indicate that they use the OAR when assessing children with acute ankle and midfoot injuries. Most physicians believe that all ankle fractures, including SH-1, are clinically significant and have a management preference for immobilization and orthopedic follow-up.

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Section: Discussionmentioning

confidence: 65%

Use of the Ottawa Ankle Rules in children: a survey of physicians’ practice patterns

Dowling

Wishart

2011

CJEM

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“…Así, su versatilidad conlleva a la aplicación por cualquier médico que labore en el servicio de emergencias y no solo por médicos traumatólogos (Runyon, 2009). Por tanto, las Reglas de Ottawa son de gran utilidad para el tamizaje de lesiones de tobillo y pie por su alta sensibilidad (alto poder de exclusión), pero con valores de especificidad variables.…”

Section: Introductionunclassified

Evaluación de conocimientos y aplicación de Reglas de Ottawa en para atención de pacientes con trauma de tobillo y medio pie y su correlación radiográfica en el servicio de emergencia.

López

Medina

Olalla

2019

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El presente estudio evalúa el conocimiento y aplicación de las reglas de Ottawa en los médicos en la atención de pacientes con trauma de tobillo y medio pie y su correlación radiográfica en el servicio de emergencia. Se detecta la alta incidencia de traumatismos de tobillo y medio pie en los servicios de emergencia del Ecuador. Se realizó un estudio descriptivo observacional transversal cuantitativo y tiene dos unidades de observación: médicos y radiografías solicitadas en la atención a pacientes con trauma de tobillo y medio pie. Se trabajó con una muestra no probabilística secuencial, donde se estudiaron 101 procedimientos o atenciones médicas y 96 radiografías solicitadas; a su vez se realizó una encuesta a 28 médicos que laboran en el servicio de emergencia. Para el análisis universal se calculó porcentajes, promedios, desviación estándar, mediana, rango intercuartílico; y para el análisis bivarial se calculó razón de momios, se utilizó la prueba exacta de Fisher como prueba de significancia estadística. Los resultados obtenidos aportan una visión de la importancia y versatilidad de las Reglas de Ottawa para trauma agudo de tobillo y medio pie en los servicios de emergencia del entorno del Ecuador. Además, al no aplicarlas se evidencia un gran número de radiografías solicitadas innecesariamente, aumentándose el tiempo de espera de pacientes, radiación recibida y mayor uso de recursos.

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“…Despite several clinical trials carried out on children, there are still worries about the usage of these rules in the pediatric age 7 . Although clinicians have knowledge about this clinical decision rule and how to apply it in clinical practice, less than 50% use it at a regular basis 2 …”

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confidence: 99%

“…6 Despite several clinical trials carried out on children, there are still worries about the usage of these rules in the pediatric age. 7 Although clinicians have knowledge about this clinical decision rule and how to apply it in clinical practice, less than 50% use it at a regular basis. 2 Therefore, the primary aims of this study were to determine the applicability of the OARs in a general pediatric ED and its reliability to safely manage ankle and midfoot injuries, the impact in reducing the number of radiographs, the healthcare costs, and the time spent in the ED.…”

mentioning

confidence: 99%

Applying the Ottawa Ankle Rules in a Pediatric Emergency Department

et al. 2021

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ObjectivesAnkle and midfoot injuries constitute one of the most frequent reasons to visit the pediatric emergency department (ED). The aims of the study were (1) to determine the feasibility of the Ottawa Ankle Rules (OARs) in a pediatric ED and its reliability to safely manage ankle and midfoot injuries and (2) to verify the impact in reducing the number of radiographs, healthcare costs, and time spent in the ED.MethodsThe prospective study enrolled 90 patients for the control group and 94 for the case group. For the control group, the standard of practice was registered. In the case group, before beginning enrolment, an instruction of how to apply the OARs were given to all clinicians. After that, OARs were applied according to patient complaints. A follow-up call was made for both groups.ResultsThe mean age of the control group was 11.9 years (standard deviation, 3.267 years), whereas in the case group was 11.3 years (standard deviation, 3.533 years). Demographic and injury characteristics were similar in both groups. A significant statistical difference was verified in the number of radiographs (P = 0.001) with a reduction of 16.7% in the case group. Patients who did not perform radiography, in the case group, spent at least 1 hour less than the ones who did. The OARs have shown a sensitivity of 100% (95% confidence interval, 39.76–100.00) and specificity of 23.33% (95% CI, 15.06–33.43) with a negative predictive value of 100%.ConclusionsThe OARs are an important clinical instrument with a high sensitivity and negative predictive value, which allows clinicians to avoid unnecessary exposure to radiation without missing clinically relevant fractures.

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Can We Safely Apply the Ottawa Ankle Rules to Children?

Cited by 9 publications

References 13 publications

Use of the Ottawa Ankle Rules in children: a survey of physicians’ practice patterns

Use of the Ottawa Ankle Rules in children: a survey of physicians’ practice patterns

Evaluación de conocimientos y aplicación de Reglas de Ottawa en para atención de pacientes con trauma de tobillo y medio pie y su correlación radiográfica en el servicio de emergencia.

Applying the Ottawa Ankle Rules in a Pediatric Emergency Department

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