Original contribution
A pooled analysis of the Ottawa ankle rules used on adults in the ED

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Abstract

A pooled analysis was conducted of the seven studies on the clinical diagnostic effectiveness of the Ottawa ankle rules when used with adult patients in the emergency department (ED). The seven studies, conducted in university and community hospital EDs, had examined the sensitivity, specificity, and positive and negative predictive values of the Ottawa ankle rules. ED physicians applied the Ottawa ankle rules with adult patients who had blunt ankle injuries. The gold standard was radiography. The combined sensitivity for the seven studies was 97% or higher for ankle/foot, original/refined Ottawa ankle rules and negative predictive value was greater than 99%. These results support the effectiveness of the Ottawa ankle rules for ruling out a fractured ankle or foot. Specificity was lower, ranging from 31% to 63%; positive predictive value was <20%. Thus, the Ottawa ankle rules should not be used for ruling in a fractured ankle or foot. This pooled analysis shows the Ottawa ankle rules to be effective as clinical practice guidelines for acute ankle and foot injuries in the adult ED patient. Patients with negative results when the rules are used are highly unlikely to have a fractured ankle or foot, but the diagnosis for positive patients is much less certain, suggesting the need for radiography.

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Cited by (28)

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    The application of OARs yielded results in diagnostic validity testing, with sensitivity values of 100% and specificity of 25%; additionally, it yielded results in diagnostic safety testing, with a positive predictive value (PPV) of 18% and a negative predictive value (NPV) of 100%.3 An analysis of several studies combined showed a sensitivity of 98.5% (confidence interval [CI] 95: 97.2–99.8), a specificity of 31.1% (95% CI: 29.2–33.0, a PPV of 16.9% (95% CI: 15.2–18.6) and an PNV of 99.3% (95% CI: 98.7–99.9).18–20 The use of the OAR significantly reduced the number of X-rays performed in the ED by approximately 30%.11,14,17,20,21 (

  • The proximal fibula should be examined in all patients with ankle injury: A case series of missed maisonneuve fractures

    2013, Journal of Emergency Medicine
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    Regardless of the criteria used to select radiographs, the clinical presentation of the MFIP almost always prompts the Emergency Physician to order ankle radiographs (as seen in all of the following cases.) Some departments order radiographs routinely, while others rely on prediction guidelines such as the Ottawa Ankle Rules (OAR) (6,7). Because the MFIP causes significant weight-bearing pain and instability, patients inevitably qualify for ankle radiographs through the “inability to take four steps” criterion of the OAR.

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    The rules were derived from an initial series of studies that were later prospectively validated. These rules have been reported to have a sensitivity of 97% to 100% [14]. All office patients presenting with a recent ankle injury should be sent for imaging if they meet the Ottawa ankle criteria.

  • Can nurses appropriately interpret the Ottawa Ankle Rule?

    2004, American Journal of Emergency Medicine
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Dr Mehta was a 4th-year medical student at Wright State University School of Medicine at the time of the study.

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