Validation of the Ottawa ankle rules in a second-level trauma center in Italy

Marinelli, Massimiliano; Giulio, A. Di; Mancini, Marisa C.

doi:10.1007/s10195-007-0156-y

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…20 22 41 45 48 50 58 66 77 For the index test domain, 58% of studies were rated as low risk of bias, 51% were low risk for patient selection and flow and timing domains and only 37% for the reference standard domain. Regarding applicability, most studies rated low for patient selection (91%), 74% for the reference standard domain and 57% for index test.…”

Section: Resultsmentioning

confidence: 99%

“…The first sensitivity analysis looked at studies at low risk of bias for all categories of QUADAS-2, and included only three studies for the Ankle and the Midfoot Rules22 48 77 and six studies for Ankle/Midfoot Rules 20 41 45 50 58 66. The second sensitivity analysis looked at studies in which the entire sample was assessed using medical imaging as the reference standard, and included 25 studies (in 24 articles) for the Ankle,7 19 22 24–27 29 36 37 39 48 53 56 62 65 67 68 74 76 77 79 82 84 12 studies (in 11 articles) for the Midfoot7 19 22 25 48 53 67 68 76 77 84 and 22 studies for the Ankle/Midfoot Rules 20 28 31 33 40 41 45 50–52 54 55 57–59 61 66 70 71 78 83 85.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis

et al. 2016

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis

et al. 2016

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“…We believe this presents an unclear risk of bias to the reference task as the radiologist interpretation remains the gold standard. In six articles, it was unclear whether the patient population was consecutively or randomly sampled [6,16,18,19,23,25]. This presents a high risk of bias for patient selection as patients were enrolled using an unclear methodology and a non-randomized allocation to control and intervention groups might have been conducted.…”

Section: Critical Appraisal Of Methodological Biasmentioning

confidence: 99%

“…The patient and study characteristics of the studies included in the meta-analysis are summarised in Table 1. Fifteen eligible studies remained for the data extraction phase, which included data for 8,560 adult participants from studies conducted in 13 countries [6,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The average age of the enrolled population ranges from 24.9 to 51 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

Diagnostic accuracy of the Ottawa ankle rule to exclude fractures in acute ankle injuries in adults: a systematic review and meta-analysis

Gomes

Chau

Banwell

et al. 2022

BMC Musculoskelet Disord

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Background Ankle traumas are common presenting injuries to emergency departments in Australia and worldwide. The Ottawa Ankle Rules (OAR) are a clinical decision tool to exclude ankle fractures, thereby precluding the need for radiographic imaging in patients with acute ankle injury. Previous studies support the OAR as an accurate means of excluding ankle and midfoot fractures, but have included a paediatric population, report both the ankle and mid-foot, or are greater than 5 years old. This systematic review and meta-analysis aimed to update and assess the existing evidence of the diagnostic accuracy of the Ottawa Ankle Rule (OAR) acute ankle injuries in adults. Methods A systematic search and screen of was performed for relevant articles dated 1992 to 2020. Prospective and retrospective studies documenting OAR outcomes by physicians to assess ankle injuries were included. Critical appraisal of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Outcomes related to psychometric data were pooled using random effects or fixed effects modelling to calculate diagnostic performance of the OAR. Between-study heterogeneity was assessed using the Higgins I2 test, with Spearman’s correlation test for threshold effect. Results From 254 unique studies identified in the screening process, 15 were included, involving 8560 patients from 13 countries. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio were 0.91 (95% CI, 0.89 to 0.92), 0.25 (95% CI, 0.24 to 0.26), 1.47 (95% CI, 1.11 to 1.93), 0.15 (95% CI, 0.72 to 0.29) and 10.95 (95% CI, 5.14 to 23.35) respectively, with high between-study heterogeneity observed (sensitivity: I2 = 94.3%, p < 0.01; specificity: I2 = 99.2%, p < 0.01). Most studies presented with low risk of bias and concern regarding applicability following assessment against QUADAS-2 criteria. Conclusions Application of the OAR is highly sensitive and can correctly predict the likelihood of ankle fractures when present, however, lower specificity rates increase the likelihood of false positives. Overall, the use of the OAR tool is supported as a cost-effective method of reducing unnecessary radiographic referral, that should improve efficiency, lower medical costs and reduce waiting times.

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“…and simple to apply, in addition, these rules have been 3, 4, 6, 20-successfully and favorably validated in various countries. 24 However, without evaluation, even well-defined decision making rules are not suitable for application in all clinical settings due to differences in patients' characteristics, different clinical settings and behavior of treating physicians. Moreover, some study results have rejected the generalization 25 of the OARs.…”

Section: Introductionmentioning

confidence: 99%

Reliability of ‘Ottawa Ankle Rules’ in Acute Ankle and Midfoot Injuries

Thakur¹,

Kandel²

2022

J Univ Coll Med Sci

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INTRODUCTIONThe Ottawa ankle rules (OARs) are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The OARs have been proven that their application reduces unnecessary radiography. MATERIAL & METHODSThis prospective study was conducted at Sumeru City Hospital, Lalitpur in the Department of Emergency and Outpatient Department of Orthopaedics. Thirty-six patients were included in the study. Twenty-five patients were in ankle group and 11 patients were in midfoot group. All patients were sent for X-rays after evaluating them according to OARs. RESULTS Among 36 cases, 8 clinically significant fractures were found. Sensitivity of OARs for detecting fractures was 100 % for both ankle and midfoot group. Specificity of OARs for detecting fractures were 47.36 % for ankle group and 66.67 % for midfoot group. Negative predictive value of OARs was 100 %. CONCLUSIONOARs are very accurate and highly sensitive tools for detecting fractures in acute ankle and midfoot injuries. Implementation of these rules would lead to significant reduction in the number of radiographs and thereby reduce the cost of the treatment, radiation exposure and waiting time of patients at hospital.

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Validation of the Ottawa ankle rules in a second-level trauma center in Italy

Cited by 8 publications

References 22 publications

Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis

Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis

Diagnostic accuracy of the Ottawa ankle rule to exclude fractures in acute ankle injuries in adults: a systematic review and meta-analysis

Reliability of ‘Ottawa Ankle Rules’ in Acute Ankle and Midfoot Injuries

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