This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Vidya T. Chande, MD

Arch Pediatr Adolesc Med. 1995;149(3):255-258.

Abstract
Objective
The Ottawa Ankle Rules (OAR) assist emergency physicians in the appropriate use of roentgenography in adults with acute ankle injuries. The OAR state that ankle roentgenograms are needed only if there is pain near the malleoli and one or more of the following exists: (1) age 55 years or older; (2) inability to bear weight; or (3) bone tenderness at the posterior edge or tip of either malleolus. This study assessed the utility of the OAR on pediatric patients with acute ankle injuries.

Design
Prospective, consecutive survey of pediatric patients with acute ankle injuries.

Setting
Pediatric emergency department of an urban university hospital.

Participants
Seventy-one children with acute ankle injuries were enrolled from July 22, 1993, to December 1, 1993.

Interventions
Twenty-four standardized clinical variables were assessed and recorded by physicians in the pediatric emergency department. The OAR were applied to each patient by the investigator to determine which ones would qualify for roentgenography.

Main Outcome Measures
Sensitivity and specificity of the OAR were calculated, as was percent reduction in roentgenograms ordered.

Results
Seventy-one of 73 eligible patients were enrolled. The two missed patients had open fractures of the tibia. Sixty-eight of 71 patients had ankle roentgenography during the visit. Fourteen patients (21%) (mean age, 11.8±4.0 years) had fractures noted on the roentgenograms. Fifty-four patients (79%) (mean age, 12.0±3.6 years) had no fracture. Application of the OAR would have reduced the number of roentgenograms ordered by 25% without missing any fractures. Sensitivity of OAR was 100% (95% confidence interval, 77% to 100%), specificity was 32% (95% confidence interval, 21% to 43%), negative predictive value was 100% (95% confidence interval, 80% to 100%), and positive predictive value was 28% (95% confidence interval, 17% to 39%).

Conclusions
Initial testing suggests that the OAR may help determine which children with acute ankle injuries could safely forgo roentgenograms without risk of missing fractures.

(Arch Pediatr Adolesc Med. 1995;149:255-258)

Author Affiliations
From the Case Western Reserve University School of Medicine and Rainbow Babies and Childrens Hospital, Department of Pediatrics, Cleveland, Ohio. Dr Chande is now with Children's Hospital of Pittsburgh (Pa).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Are the Ottawa ankle rules helpful in ruling out the need for x ray examination in children?
Myers et al.
Arch. Dis. Child. 2005;90:1309-1311.
FULL TEXT  

Do All Ankle Injuries Need Radiographs?
Paul
AAP Grand Rounds 2003;9:67-67.
FULL TEXT  

Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review
Bachmann et al.
BMJ 2003;326:417-417.
ABSTRACT | FULL TEXT  

The Ottawa ankle rules in children
Yuen and Saunders
Emerg. Med. J. 2001;18:466-467.
FULL TEXT  

The Ottawa Ankle Rules and missed fractures of the talus
Warren and Knottenbelt
Emerg. Med. J. 2001;18:521-521.
FULL TEXT  

Rate of Abnormal Osteoarticular Radiographic Findings in Pediatric Patients
Petit et al.
Am. J. Roentgenol. 2001;176:987-990.
ABSTRACT | FULL TEXT  

Prospective Evaluation of the Ottawa Ankle Rules in a University Sports Medicine Center: With a Modification to Increase Specificity for Identifying Malleolar Fractures
Leddy et al.
Am J Sports Med 1998;26:158-165.
ABSTRACT | FULL TEXT  

REDUCING X-RAYS IN CHILDREN WITH ANKLE INJURIES
JWatch General 1995;1995:4-4.
FULL TEXT