Implementation of the Ottawa ankle rules by general practitioners in an emergency department of a Turkish district hospital

Daş, Murat; Temiz, Aytun; Çevik, Yunsur

doi:10.5505/tjtes.2016.72662

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…Referrals for imaging were excluded from the study if participants were under 18 years of age, returning for follow-up imaging, presenting with a multi-trauma, had an injury more than two weeks old, had cognitive impairment (including intoxication), had an incomplete examination, had an inflammatory, neurological or musculoskeletal condition that impeded ankle joint function, the referral gave no fracture subscription (i.e., query foreign body, prosthesis position), or requested imaging for a known dislocation or post-reduction of a dislocation. This is consistent with previous literature ( Daþ, Temiz & Çevik, 2016 , p. 362; Pijnenburg et al, 2002 , p. 601).…”

Section: Methodssupporting

confidence: 94%

“…The OAR have been widely applied in many countries ( Daþ, Temiz & Çevik, 2016 ) and there have been active dissemination and education strategies developed to encourage clinicians to incorporate them into practice ( Cameron & Naylor, 1999 ). However, Cameron & Naylor (1999) report that OAR have not been universally adopted into practice, potentially due to the convenience of referring patients with ankle trauma for imaging, or due to practitioners’ concerns around litigation ( Pires et al, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

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Adequacy of clinical information in X-ray referrals for traumatic ankle injury with reference to the Ottawa Ankle Rules—a retrospective clinical audit

Gomes

Chau

Banwell

et al. 2020

PeerJ

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Study Objective To assess the adequacy of clinical information with reference to the Ottawa Ankle Rules (OAR) in X-ray referrals for adults with traumatic ankle injury in the ED of a South Australian tertiary hospital and report upon referring trends between emergency department clinicians. Methods A retrospective clinical audit of adult ankle X-ray referrals in the emergency department was conducted. Eligible referrals were screened for their adherence to the OAR, patient details, clinical history and referrer. A logistic regression was used to determine the influence of these factors on the likelihood of being referred for X-rays despite not meeting the OAR criteria. Sensitivity, specificity, positive and negative likelihood ratios and their associated confidence intervals were calculated to assess the diagnostic accuracy of the OAR for those referred. Results Out of the 262 eligible referrals, 163 were deemed to have met the criteria for the OAR. Physiotherapists showed the highest OAR compliance of 77.3% and were the most accurate in their use of the rules, with a sensitivity of 0.86. Medical officers, registrars and interns were 2.5 times more likely to still refer a patient for X-ray if they did not meet the OAR criteria, compared to physiotherapists as the baseline. Patient age, duration of injury etc. were not significantly associated with likelihood of referral (even when they did not meet OAR criteria). The overall sensitivity, specificity, positive and negative likelihood ratios of the OAR were 0.59 (95% CI [0.47–0.71]), 0.37 (95% CI [0.30–0.44]), 0.93 (95% CI [0.76–1.16]) and 1.10 (95% CI [0.82–1.48]) respectively. Conclusion The results of this audit demonstrated poor sensitivity and moderate compliance by referrers with the rule. Reasonable evidence exists for the implementation of individual and/or institutional-based change strategies to improve clinician compliance and accuracy with use of the OAR.

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Section: Methodssupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Adequacy of clinical information in X-ray referrals for traumatic ankle injury with reference to the Ottawa Ankle Rules—a retrospective clinical audit

Gomes

Chau

Banwell

et al. 2020

PeerJ

View full text Add to dashboard Cite

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“…By minimizing unnecessary radiography, this clinical tool streamlines the diagnostic process and facilitates more efficient use of emergency department resources. [13,14] However, the limitations of the OAR must be recognized. Specifically, given the risk of overlooking certain fracture types, a holistic approach that incorporates clinical evaluation and patient history is essential.…”

Section: Discussionmentioning

confidence: 99%

The role of Ottawa ankle rules in geriatric emergency department visits

Seyhan

2024

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Ankle injuries are a common reason for visits to the emergency department (ED). An effective diagnosis and treatment process is crucial for the swift recovery of patients and for alleviating congestion in EDs. This study aims to evaluate the adequacy and effectiveness of the Ottawa Ankle Rules (OAR) in geriatric patients presenting to the emergency department (ED). METHODS:Between February 2022 and November 2022, 160 patients aged 65 and older (118 women, 42 men) who presented to the ED with isolated ankle injuries were included in the study. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the OAR. RESULTS:The study found fractures in 37.5% of patients. The sensitivity of the OAR was 98.33%, the specificity was 86%, the negative predictive value was 98.85%, and the positive predictive value was 80.82%. CONCLUSION:This study demonstrates that the OAR is highly sensitive in the geriatric population but shows some limitations in terms of specificity and positive predictive value. These results support the effectiveness of using the OAR in evaluating ankle injuries in the geriatric population but also highlight the need for cautious application due to the potential for false-positive outcomes.

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“…[38][39][40] This would suggest a risk of a patient failing to receive baseline imaging if evidence-based guidelines for imaging are followed. Because the Ottawa Ankle Rules do not always achieve 100% sensitivity, [41][42][43] it may be of value to add medial cuneiform tenderness to the rules to minimize the chance of a missed fracture. Other authors have similarly suggested updates to the Ottawa Ankle Rules to improve overall yield.…”

Section: Discussionmentioning

confidence: 99%

Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies

Mabry¹,

Patti²,

Ross³

et al. 2021

Journal of the American Podiatric Medical Association

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Background Isolated medial cuneiform fracture is a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptoms. An understanding of clinical presentation is needed to expedite diagnosis, facilitate decision making, and guide treatment approach. Methods Case studies/series were searched in four databases until September 2019. Included studies had participants with a history of traumatic closed medial cuneiform fracture. Studies were excluded if the medial cuneiform fractures were open fractures, associated with multitrauma, or associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies, and a qualitative synthesis was performed. Results Ten studies comprising 15 patients were identified. Mean ± SD patient age was 38.0 ± 12.8 years, with 86.7% of reported participants being men. The overall methodological quality was moderate to high, and reporting of the patient selection criteria was poor overall. The most commonly reported clinical symptoms were localized tenderness (60.0%) and edema (53.3%). Direct blow was the most common inciting trauma (46.2%), followed by axial load (30.8%) and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of patients; magnetic resonance imaging and computed tomography were the most common diagnostic modalities. Mean ± SD diagnostic delay was 64.7 ± 89.6 days. Conservative management was pursued in 54.5% of patients, with reported resolution of symptoms in 3 to 6 months. Surgical intervention occurred in 45.5% of patients and resulted in functional restoration in 3 to 6 months in all but one patient. Conclusions Initial radiographs for isolated medial cuneiform fractures are frequently occult. Due to expedience and relatively low cost, radiographs are still a viable first-line imaging modality. If clinical concern remains, magnetic resonance imaging may be pursued to minimize diagnostic delay. Conservative management is a viable treatment method, with expected return to full function in 3 to 6 months.

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Implementation of the Ottawa ankle rules by general practitioners in an emergency department of a Turkish district hospital

Abstract: BACKGROUND:The present objective was to assess implementation of the Ottawa ankle rules (OAR) as a method of fracture prediction in the emergency department (ED) of a Turkish state hospital.

Cited by 7 publications

References 15 publications

Adequacy of clinical information in X-ray referrals for traumatic ankle injury with reference to the Ottawa Ankle Rules—a retrospective clinical audit

Adequacy of clinical information in X-ray referrals for traumatic ankle injury with reference to the Ottawa Ankle Rules—a retrospective clinical audit

The role of Ottawa ankle rules in geriatric emergency department visits

Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies

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