Pdf the sonographic ottawa foot and ankle rules study the. Yes no for patients with acute trauma to the ankle bone tenderness at a bone tenderness at b inability to bear weight both immediately and in the ed an ankle radiographic series is only required if there is any pain in the malleolar zone and any of these. Limited data support its use by other health care workers in children. The ottawa ankle rules oar are a set of clinical decision rules that were derived and validated by stiell et al. More recent evidence also supports the ottawa ankle rules as an accurate instrument for excluding fractures of. Ottawa ankle rules ottawa health research institute. Ottawa ankle rules for ankle injury radiography an ankle xray series is only required if there is any pain in the malleolar zone and any of these findings. The oar are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. To summarise the evidence on accuracy of the ottawa ankle rules, a decision aid for excluding fractures of the ankle and midfoot.
Data sources medline, embase, cinahl, sportdiscus and cochrane library. 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. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot in children. In emergency departments patients with an acute ankle sprain, are the ottawa ankle rules accurate for excluding fractures of the ankle and midfoot. The ottawa ankle rule is useful in ruling out fracture high sensitivity, but. Update on acute ankle sprains american family physician. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. 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. The rules are designed to aid the early identification of a fracture while reducing unnecessary radiography in patients who have negative clinical findings. Diagnostic accuracy and reproducibility in the interpretation of ottawa ankle and foot rules by specialized emergency nurses.
Ottawa ankle rules ottawa hospital research institute. Pdf diagnostic accuracy and reproducibility in the. Ottawa rules simplify the management of ankle injuries. Diagnostic accuracy of the ottawa ankle and midfoot rules. The ottawa knee rules are useful in ruling out fracture high sensitivity when negative, but poor for ruling in fractures many false positives. Comparison of ottawa ankle rules and bernese ankle rules in acute ankle and midfoot injuries injury during daily walking, and the remaining reported other reasons. Use of these rules reduced radiographic examinations by 28% for the ankle and 14% for the foot. Feb 22, 2003 to summarise the evidence on accuracy of the ottawa ankle rules, a decision aid for excluding fractures of the ankle and mid foot. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. Pdf validation of the ottawa ankle rules for acute foot and ankle. Inability to bear weight either initially, or on examination, requires radiography. Clinical usefulness of the ottawa ankle rules for detecting fractures of the ankle and midfoot. Ankle and foot ottawa ankle rules guideline for the administered by the alberta medical association this guideline has been adapted by an alberta clinical practice guidelines program working group from the ottawa ankle rules developed by dr. The oars met the criteria for radiographs in 100 of the 124 cases, of which 38 were actually referred for imaging.
Multicentre trial to introduce the ottawa ankle rules for use of radiography in acute ankle injuries. Ankle injuries account for nearly 2 million visits to the emergency department ed in the united states and canada each year. The ottawa ankle rules oars aim to determine if a patient presenting with acute ankle or foot traumarelated pain requires plain radiographs of the foot or ankle to exclude a fracture. Validation of the ottawa ankle rules for acute foot and ankle.
Ottawa rules regarding requirement for ankle xray general. Effect of triagebased use of the ottawa foot and ankle rules. Mar 06, 20 how to use the ottawa ankle and foot rule. The ottawa rules have been described and evaluated by steil et al 1,2. The accuracy of the ottawa knee rule to rule out knee fractures. Review methods data were extracted on the study population, the type of ottawa ankle rules used, and methods. The ottawa ankle rules have a high sensitivity for excluding. Foot and ankle injuries are common presentations to the emergency department. Foot and ankle injuries are common in the emergency department ed. Rules have been prospectively validated on multiple occasions.
A foot xray is required if there is any pain in the midfoot zone and any of these findings. We conclude that implementing ottawa ankle rule can identify all clinically relevant fractures of ankle and foot. A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma. Eligibility criteria for selecting studies primary diagnostic studies reporting. Eligibility criteria for selecting studies primary diagnostic studies. The ottawa ankle rules and missed fractures of the talus. Pdf the original and modified ottawa ankle rules oars were developed as clinical decision rules cdrs for use in the emergency. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot. Jun 15, 2012 dowling s, spooner ch, liang y, et al. Validation of the ottawa ankle rules in children with ankle injuries. Ottawa ankle rules an overview sciencedirect topics. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging. Ottawa ankle and foot rules an ankle xray is required only if there is any pain in malleolar zone and any of these findings. Of those requiring radiographs in accordance with the ottawa foot and ankle rules, approximately 22% have a fracture.
What are the ottawa ankle rules and how are they used to. 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. The ottawa ankle rules and subjective perception of foot andor ankle fractures were evaluated on the questionnaire. The ottawa ankle rules are physical exam findings that help predict the likelihood of an osseous ankle injury. Accuracy of ottawa ankle rules to exclude fractures of the. The ottawa ankle rules ankle fracture clinical prediction rule duration. Stiell ig, greenberg gh, mcknight rd, nair rc, mcdowell i, worthington jr. Acute foot and ankle injuries can make it difficult to rule out bony injuries, therefore the ottawa rules can help practitioners to clinically reason if radiological. Comparison of ottawa ankle rules and bernese ankle rules.
Ottowa ankle rules order form unc school of medicine. Before the introduction of the rules most patients with ankle injuries would have been imaged. The sonographic ottawa foot and ankle rules study the sofar. The ottawa ankle and foot rules to image or not to. More recent evidence also supports the ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid foot. The ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury. Ottawa ankle rules this guideline will aid you in determining which patients require an xray of their ankle. The need for need for radiography is reduced by 36% saving patients money and time.
Exclusions less than 18 years old intoxication multiple painful injuries pregnant head injury diminished sensation due to neurological deficit recommendations. The specificity of the ottawa ankle rules does not help rule in an ankle or foot fracture. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. 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. Mar 07, 20 the ottawa knee and ankle rules are a validated set of assessment tools to help the clinician decide whether an xray is needed after an acute injury to the knee or the foot and ankle. A group of ottawa emergency physicians developed the two rules described above, and their application reduced radiographic examinations by 28% for the ankle, and 14% for the foot, that is, by 27 and 17. Basketball season is back and with it comes a new season of early morning conditioning runs, late night pickup games, and of course, a few ankle sprains along the way. Electronic databases, reference lists of included studies, and experts. The ottawa ankle rules oar are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries.
Comparison of ottawa ankle rules and bernese ankle rules in. Rules out clinically significant foot and ankle fractures to reduce use of xray imaging. Pdf validation of the ottawa ankle rules for acute foot and. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. Tenderness of patella is significant only if an isolated finding. Based on radiographic findings in an acute setting, the oars n 38 had a high sensitivity. Ankle radiographs are suggested if there is pain in the malleolar region with any of the following. 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. The ankle component of the oar states that radiographic evaluation of the ankle is only necessary if there is pain in the malleollar zone and one of the. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries.
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