Utilization of the Ottawa Ankle Rules by Nurses in a Pediatric Emergency Department

Karpas, Anna; Hennes, Halim; Walsh‐Kelly, Christine M.

doi:10.1111/j.1553-2712.2002.tb00229.x

Cited by 29 publications

(18 citation statements)

References 9 publications

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“…The Ottawa Ankle Rules (OAR) (34)(35)(36) that were developed by Ottawa emergency physicians were adopted to assist in determining if radiography should be used to determine whether radiography would be appropriate to diagnose ankle fracture in a patient experiencing ankle pain. It has been demonstrated that when pediatric emergency department (ED) nurses accurately apply and interpret OAR, children in the hospital ED were treated with a nursing collaborative practice protocol (CPP) to minimize throughput time and expedite patient care (37). This suggests that CPP may be a novel treatment in children with fractured ankles and NMP may be used as a part of CPP.…”

Section: Discussionmentioning

confidence: 99%

N‑methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen‑activated protein kinase signaling pathway

et al. 2018

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Abstract. N-methyl pyrrolidone (NMP), a small bioactive molecule, has the potential to stimulate bone formation and inhibit osteoclast differentiation. The aim of the present study was to investigate the effect of NMP on the inflammatory response and underlying molecular mechanisms in MG-63 cells. The mRNA and protein expression of cytokines from peripheral blood in children with or without ankle fracture were determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and ELISA, respectively. MG-63 cells were pre-treated with/without NMP and stimulated with 1 µM bradykinin (BK). The production of cytokines from MG-63 cells was assessed by western blotting and RT-qPCR. The expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) mRNA and protein were measured using western blotting and/or RT-qPCR. Western blotting was used to examine the activation level of mitogen activated protein kinase. Compared with healthy children, levels of tumor necrosis factor (TNF-α), interleukin (IL)-1β and IL-6 mRNA and protein were upregulated in children with ankle fracture. NMP treatment did not induce cytotoxicity in MG-63 cells. The BK-induced upregulation of TNF-α, IL-1β, IL-6, iNOS and COX-2 mRNA and protein was reversed in a dose-dependent manner by NMP. Furthermore, NMP downregulated the activation of c-Jun NH2-terminal kinase and p38 pathways, but not the extracellular signal-related kinase pathway. Therefore, the results of the current study demonstrate that NMP inhibits inflammation dependent on the mitogen-activated protein kinase pathway in MG-63 cells, indicating that it may be beneficial in the healing of fractures.

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Section: Discussionmentioning

confidence: 99%

N‑methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen‑activated protein kinase signaling pathway

et al. 2018

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“…[6][7][8][9][10] Numerous studies have examined nurses' interpretation and application of the OAR. [11][12][13][14] It is clear that the use of the OAR by nurses results in similar diagnostic performance for fracture detection as when the rules are applied by physicians, 15,16 and thus it is believed that emergency nurses can accurately determine which patients require radiographs in the setting of isolated blunt ankle injury. 11,13,16 What remains unclear, however, is whether or not triage nurse initiated ankle radiography shortens ED patients' length of stay (LOS), a factor known to be correlated with patient satisfaction.…”

Section: Introductionmentioning

confidence: 99%

Effect of Triage Nurse Initiated Radiography Using the Ottawa Ankle Rules on Emergency Department Length of Stay at a Tertiary Centre

Lee

Filiatrault

Abu‐Laban

et al. 2015

CJEM

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Objective: To determine the effect of triage nurse initiated radiographs using the Ottawa Ankle Rules (OAR) on emergency department (ED) throughput. We hypothesized OAR use would reduce median ED length of stay (LOS) by 25 minutes or more. Methods: A randomized controlled trial was conducted at a tertiary centre ED with an annual census of over 90,000 patients. Adult patients presenting within 10 days of isolated blunt ankle trauma were eligible. Participants were randomly assigned to standard triage or OAR application by 15 explicitly trained triage nurses. Our primary outcome was ED LOS. Secondary outcomes included triage nurses' and patients' satisfaction. A power calculation indicated 142 patients were required. The Mann-Whitney U test was used to compare the medians between the two groups. Results: Of 176 patients with blunt ankle injury screened, 146 were enrolled (83.0%); baseline characteristics in the two groups were similar. The median/mean ED LOS in the control and OAR groups were 128/143 minutes and 108/115 minutes respectively (median difference 20 minutes; p = 0.003). Agreement in OAR use between emergency physicians and nurses was moderate (kappa 0.46/0.77 for foot/ankle rule components), and satisfaction of both nurses and participants was high. Conclusion: Triage nurse initiated radiography using OAR leads to a statistically significant decrease of 20 minutes in the median ED LOS at a tertiary care centre. The overall impact of implementing such a process is likely site-specific, and the decision to do so should involve consideration of the local context. RÉSUMÉObjectif: L'étude visait à déterminer l'effet du triage des patients par le personnel infirmier par la prescription de radiographies selon les règles d'Ottawa concernant les blessures de la cheville, sur le flux des patients au service des urgences (SU). Selon l'hypothèse émise, l'application des règles permettrait de réduire la durée médiane de séjour (DS) de 25 minutes ou plus.Méthode: Un essai comparatif à répartition aléatoire a été mené dans un SU d'un centre de soins tertiaires, qui reçoit plus de 90 000 patients par année. Les adultes qui consultaient pour une tuméfaction isolée de la cheville dans les 10 jours suivant un trauma pouvaient être sélectionnés. Les participants étaient dirigés au hasard vers le groupe de triage habituel ou vers le groupe des règles d'Ottawa, appliquées par 15 infirmières ou infirmiers spécialement formés à cet effet. Le principal critère d'évaluation était la DS au SU. Les critères secondaires comprenaient le degré de satisfaction des patients et du personnel infirmier affecté au triage. D'après un calcul de la puissance de l'étude, le nombre nécessaire de patients à traiter devait atteindre 142. La comparaison des valeurs médianes entre les deux groupes a été effectuée à l'aide du test de Mann-Whitney. Résultats: Sur 176 patients sélectionnés pour une contusion à la cheville, 146 ont participé à l'étude (83,0 %), et les caractéristiques de base dans les deux groupes étaient comparables. Les du...

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“…However, some pediatric-specific pathways have been shown to have an effect on ED patient flow. [73][74][75] Developing emergency care pathways that adequately address pediatric issues and prioritize problems in accordance with those of adults is a priority. An increasing number and quality of pediatric-specific triage pathways are available, the most notable being the 5-level triage system.…”

Section: Emergency Care Pathwaysmentioning

confidence: 99%

Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

Barata¹,

Brown²,

Fitzmaurice³

et al. 2015

Pediatrics

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This report provides a summary of best practices for improving flow, reducing waiting times, and improving the quality of care of pediatric patients in the emergency department. CURRENT STATUS AND NEEDS ED Use and ED Crowding in the United StatesApproximately 800 000 children seek care in the emergency department (ED) each day in the United States. Additionally, it is estimated that 3.4% of US children use EDs as their source for sick care. The vast majority (92%) of these children are seen in community EDs, with a smaller percentage seen in pediatric EDs. The increase in ED utilization has saturated the capacity of EDs and emergency medical services in many communities. Increases in patient volume and decreases in resources, including fragmentation of resources and shortage of critical subspecialists, have resulted in EDs facing crowding and ambulance diversion.The need for emergency medical services outstrips the available resources on a daily basis. This mismatch is reflected by the considerable increase in the number of patients visiting EDs. In 1993, 90.3 million patients visited EDs; in 2003 that number increased to 113.9 million patients. Approximately 21% of these patients were younger than 15 years. Despite the increase in ED visits, the number of hospitals decreased by 703, the number of hospital beds decreased by 198 000, and the number of EDs decreased by 425.

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Utilization of the Ottawa Ankle Rules by Nurses in a Pediatric Emergency Department

Abstract: Trained nurses can accurately apply and interpret the OAR. The incorporation of the OAR into the nursing assessment of children with acute ankle injuries may reduce the number of radiographs ordered.

Cited by 29 publications

References 9 publications

N‑methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen‑activated protein kinase signaling pathway

N‑methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen‑activated protein kinase signaling pathway

Effect of Triage Nurse Initiated Radiography Using the Ottawa Ankle Rules on Emergency Department Length of Stay at a Tertiary Centre

Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

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