During the subsequent decade, successive papers have reproduced stiells findings and established the ottawa ankle rules as a safe, cost effective, and reliable approach to assessing injured ankles with impressive consistency when applied by senior emergency doctors, junior doctors in training, and nurse practitioners. Pdf application of ottawa ankle rules researchgate. Ottawa ankle rules ottawa hospital research institute. Using the ottawa ankle rules, xray imaging can be reduced 34% for the ankle series and 30% for the foot series.
Pdf abstract ankle injury is a common injury sustained in an outdoor activity. 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. Prospectively validated in 1993 by stiell et al, 3 the ottawa ankle rule requires localized bone tenderness of the posterior edge or tip of either malleolus or the inability to bear weight both immediately after the injury or in the ed. Multicentre trial to introduce the ottawa ankle rules for. Bone tenderness at the posterior edge or tip of the lateral malleolus a or. Ottawa knee rule ottawa hospital research institute. Decision rules for the use of radiography in acute ankle injuries.
Ottawa ankle rules for the injured ankle british journal of. Accuracy of the ottawa ankle rules applied by nonphysician. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. Multicentre trial to introduce the ottawa ankle rules for use. Ian stiell, the father of clinical decision rules, shares with us his views and experiences gained from cocreating some of the most influential cdrs and risk scales to date. We conclude that implementing ottawa ankle rule can identify all clinically relevant fractures of ankle and foot. Use of the rules over a prolonged period of time by many physicians of varying experience led to a decrease in ankle radiography, waiting times, and costs without an increased rate of missed fractures. 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. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging.
A study to develop clinical decision rules for the use of radiography in acute ankle. The original derivation study by stiell et al was done. Ottawa ankle rules the ottawa hospital research institute. Nurse practitioners treating ankle and foot injuries using. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of a knee injury using the ottawa knee rules. The rules have been demonstrated to decrease unnecessary diagnostic imaging and emergency room wait times which enhances patient comfort and reduces health care costs. A later article 2 encapsulated ian stiells motivation in drawing up the ottawa ankle rules oar. Ankle sprains are a common occurrence in athletes as well as the general population.
Ottaaw ankle rules for ankle injury radiography stiell ig, mcknight rd, greenberg gh, et al. The ottawa ankle rules oar are a set of clinical decision rules that were derived and validated by stiell et al. The ottawa ankle rules are contingent upon the patient presenting within 10 days of the injury. Effect of triage nurse initiated radiography using the ottawa. 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. 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. Ottawa rules pdf ottawa rules pdf ottawa rules pdf download. Stiell ig, mcdowell i, nair rc, aeta h, greenberg g, mcknight rd, ahuja j. Nurse practitioners nps in the emergency department ed have been trained to assess a range of clinical problems and minor complaints such as acute ankle injury. The ottawa ankle rules oar are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. The ottawa foot rule was also validated during the same study and requires bone tenderness at the base of the fifth metatarsal, bone tenderness at the. A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma. Ottaaw knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. The ottawa ankle rules, developed by stiell, specifies the criteria to be met before ordering xrays for a patient presenting with an acute ankle injury.
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. Stiell and colleagues developed the concept of a clinical decision rule to guide the assessment of ankle injuriesin particular. Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa. Using the diagram below we can determine when an ankle series is required. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the. Limited data support its use by other health care workers in children. Stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. Validation of the ottawa ankle rules in children with ankle injuries. Ottawa ankle rules accurately assess injuries and reduce. The ottawa ankle rules determine the need for radiographs in acute ankle injuries. 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.
Racgp the ottawa knee rules a useful clinical decision tool. Awareness and use of the ottawa ankle and knee rules in 5 countries. Less than a decade ago, clinical epidemiologist ian stiell, working with emergency department physicians, formulated the ottawa ankle rules. The ottawa ankle rule project demonstrated that more than 95% of patients with. Conclusion we have derived the canadian cspine rule, a highly sensitive decision rule for use of cspine radiography in alert and stable trauma patients. The ottawa ankle rules and missed fractures of the talus. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. Future studies should address the generalizability of these decision rules in a variety of hospital settings. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of. The original rules were intended to identify all clinically signi. What are the ottawa ankle rules and how are they used to. Before the introduction of the rules most patients with ankle injuries would have been imaged.
Stiell ig1, greenberg gh, mcknight rd, nair rc, mcdowell i, reardon m, stewart jp, maloney j. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. This screening tool was developed because of the need for a rapid and accurate way to avoid unnecessary imaging. Since the publication of this study, the ottawa ankle rule have been well validated and have been shown to limit the number of radiographs obtained for ankle injuries, decreased patient wait times and cost. Xray requesting patterns before and after introduction of the ottawa knee rules in a uk emergency department. Ottawa ankle clinical decision instrument derivation study. If a patient does not exhibit any of the criteria of the ottawa ankle rules, radiographs of the foot or ankle are unnecessary sor. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Implementation of the ottawa ankle rules would result in significant savings of health care dollars despite the cost of missed fractures including litigation costs. Implementation of the ottawa ankle rules jama jama network. Use of these rules reduced radiographic examinations by 28% for the ankle and 14% for the foot. Implementation of the ottawa knee 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. Multicentre trial to introduce the ottawa ankle rules for use of radiography in acute ankle injuries.
Stiell ig, greenberg gh, mcknight rd, nair rc, mcdowell i, worthington jr. Validation of ottawa ankle rules protocol in greek. However the vast majority of patients with unclear ankle injuries do not have bone fractures. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot. Discuss the history, exam findings, and ottawa rules with patients. Update on acute ankle sprains american family physician. Pdf accuracy of ottawa ankle rules to exclude fractures. There are hundreds of clinical decision rules and risk scales published in the medical literature, some more widely adopted than others. The rules are intended to guide clinical decisions about the efficient use of radiography in the diagnosis of malleolar zone fractures and midfoot zone fractures, minimising expenditure.
Ankle sprains should be evaluated using the ottawa ankle rules figure 2 3, which are wellestablished clinical guidelines used to determine the need for radiography. Ian stiell shares with us his views and experiences gained. Accuracy of ottawa ankle rules to exclude fractures of the. 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. Anton helman, december 2014 clinical decision rules cdrs. 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. To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. The ottawa knee rules were developed in an attempt to allow physicians to be more selective with radiography, without missing fractures. Future studies should address the generalizability of these decision rules in a variety of. Sep 02, 1995 conclusionsintroduction of the ottawa ankle rules proved to be feasible in a large variety of hospital and community settings. There are hundreds of clinical decision rules and risk scales. Decision rules for the use of radiography in acute ankle. Based on the ottawa ankle rules, stiell et al recommended xray evaluation after an ankle sprain for the following.
Costeffectiveness analysis of the ottawa ankle rules. Conclusionsintroduction of the ottawa ankle rules proved to be feasible in a large variety of hospital and community settings. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. Racgp the ottawa knee rules a useful clinical decision. This study compared assessment of suspected ankle and foot injuries using the ottawa ankle rules oar by nps and ed medical doctors eddrs.
Implementation of the ottawa ankle rules in a university sports medicine center. The oar are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. The combined ottawa ankle and foot rules have a sensitivity of 97. In the united states, most ankle injuries are evaluated radiographically, 1,2 even though only about 15% are found to involve fractures. Ottawa ankle rules an overview sciencedirect topics. An ankle xray series is only required if there is any pain in the malleolar zone and. Ottawa ankle rules for the injured ankle british journal. The canadian cspine rule for radiography in alert and. The oar project had demonstrated that more than 95% of patients with ankle injuries had radiographic examinations, but that 85% of the radiographs showed no fractures. The canadian cspine rule for radiography in alert and stable trauma patients. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. Prospective validation of a decision rule for the use of radiography in acute knee injuries. This is in contradistinction to the ottawa ankle rule.
Pdf accuracy of ottawa ankle rules to exclude fractures of. Patients 55 years and older not the typical ncaa college basketball athlete 2. Those that were unable to bear weight for 4 steps both at the time of injury and during evaluation. Prior to the creation of the ottawa ankle decision instrument, most patients presenting to the emergency room with a complaint of acute ankle injury had ankle and or foot radiographs ordered to evaluate for fracture, even though the incidence of fracture among this population is relatively low 15%. Get a printable copy pdf file of the complete article 915k, or click on a page. The ottawa ankle rules can significantly decrease the number of unnecessary ankle radiographs. For ankle injury radiography a an ankle xray series is only required if there is any. Safety and efficiency of the ottawa ankle rule in a swiss population. 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. 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. If prospectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in ed use of cspine radiography. Editor,further to previous correspondence i think the use of the ottawa ankle rule needs some clarification. Effect of triagebased use of the ottawa foot and ankle.
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