Comparison of diagnostic decision rules and structured data collection in assessment of acute ankle injury

Glas, Afina S.; Pijnenburg, Bas A.C.M.; Lijmer, Jeroen G.; Bogaard, Kjell; De Roos, Marnix A.J.; Keeman, Johannes N.; Butzelaar, Rudolf M.J.M.; Bossuyt, Patrick M.M.
March 2002
CMAJ: Canadian Medical Association Journal;3/19/2002, Vol. 166 Issue 6, p727
Academic Journal
Background Ankle decision rules help to determine which patients with ankle injuries should undergo radiography. However, these rules are limited by imperfect generalizability and sensitivity. The judgement of physicians, aided by structured data collection, is a potential alternative. We compared the diagnostic performance of 2 decision rules with the performance of physicians, aided by structured data collection, in ruling out fracture in patients with acute ankle injury. Methods Consecutive patients with acute ankle injury who visited the emergency department of a teaching community hospital in Amsterdam were included in the study. After taking the patient's history and performing a physical examination, the surgical resident in each case completed a specially developed structured data form incorporating all of the variables in the Ottawa and Leiden ankle rules, as well as some additional variables. The form then asked whether the resident thought radiography was necessary. Each patient then underwent ankle and midfoot radiography. The films were independently interpreted by a radiologist and a trauma surgeon, who were both blinded to the information on the data form. Sensitivity, specificity and the percentage of patients for whom radiography was recommended were the main outcome measures. Results Of 690 consecutive patients, 647 met the inclusion criteria. Fractures were observed in 74 (11%) of these patients. Sensitivity was 89% (95% confidence interval [CI] 80% to 95%) for the Ottawa ankle rules, 80% (95% CI 69% to 88%) for the Leiden ankle rule and 82% (95% CI 72% to 90%) for physicians' judgement. Specificity was 26% (95% CI 23% to 30%), 59% (95% CI 55% to 63%) and 68% (95% CI 64% to 71%) respectively. Radiography was recommended in 76% (95% CI 72% to 79%), 46% (95% CI 42% to 50%) and 38% (95% CI 34% to 42%) of cases respectively. The Ottawa rules missed 8 fractures, of which 1 was clinically significant, the Leiden rule missed 15 fractures, of which 5...


Related Articles

  • Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle... Stiell, Ian; Wells, George // BMJ: British Medical Journal (International Edition);9/2/95, Vol. 311 Issue 7005, p594 

    Assesses the feasibility and impact of introducing the Ottawa ankle rules (OAR) in diagnosing acute ankle injuries to physicians working in a wide variety of hospital and community settings in Great Britain. Reduction in the ordering of ankle radiographic series following the introduction of...

  • GUIDELINES FOR MANAGING ANKLE INJURIES: The Ottawa Ankle Rules. Squillace, Susan P.; Slawson, David C. // Journal of Family Practice;Dec1994, Vol. 39 Issue 6, p593 

    This article discusses the study "Implementation of the Ottawa Ankle Rules," by I. G. Stiell, R. D. McKnight, G. H. Greenberg, I. McDowell, R. C. Nair, G. A. Wells and C. Johns. It explains that the study aims to answer whether or not the instruction of physicians in the implementation of the...

  • Chronic Ankle Pain After An Initial 'Twisting' Injury To The Ankle. AYKANAT, Faruk; KOSE, Ozkan // Turkish Journal of Emergency Medicine;2014, Vol. 14 Issue 2, p46 

    The article presents a case study of 42-year old woman with chronic left ankle pain that began after having a twisting ankle injury. She was admitted to an emergency department, where she underwent foot radiography. She was diagnosed with fracture of anterior superior process of calcaneus...

  • The clinical anatomy of examination of the ankle. Ellis, Harold // British Journal of Hospital Medicine (17508460);Nov2010 Supplement, Vol. 71, pM170 

    The article presents information on clinical anatomy and examination of injured ankle joints. It is stated that accurate clinical assessment of wound injury mostly depends on proper knowledge of anatomy of ankle as well as foot. Clinical examination of injured ankle is different for fracture and...

  • How to evaluate the quality of fracture reduction and fixation of the wrist and ankle in clinical practice: a Delphi consensus. Beerekamp, M. S.; Haverlag, R.; Ubbink, D. T.; Luitse, J. S.; Ponsen, K. J.; Goslings, J. C. // Archives of Orthopaedic & Trauma Surgery;Jun2011, Vol. 131 Issue 6, p739 

    Method: A Delphi study was conducted to obtain consensus on the most important criteria for the radiological evaluation of the reduction and fixation of the wrist and ankle. The Delphi study consisted of a bipartite online questionnaire, focusing on the interpretation of radiographs and CT scans...

  • Stress fractures of the ankle malleoli diagnosed by ultrasound: a report of 6 cases. Bianchi, Stefano; Luong, Dien // Skeletal Radiology;Jun2014, Vol. 43 Issue 6, p813 

    Objective: To present the ultrasound appearance of stress fractures (SF) of the ankle malleoli. Material and Methods: We present a retrospective review of 6 patients (4 women and 2 men, with an age range of 24-52 years, mean age of 39 years) in which ultrasound diagnosed, together with the...

  • Radiographic evaluation of the ankle syndesmosis. Croft, Stephen; Furey, Andrew; Stone, Craig; Moores, Carl; Wilson, Robert // Canadian Journal of Surgery;Feb/fev2015, Vol. 58 Issue 1, p58 

    Background: Radiographic measurements to document ankle anatomy have been suggested in recent literature to be inadequate. Focus has been put on stress views and computed tomography; however, there are also issues with these modalities. An orthogonal view that could be used both statically and...

  • Faster return to play seen after lateral ankle vs. syndesmosis sprains in NFL players. Buddie, Renee Blisard // Orthopedics Today;Aug2012, Vol. 32 Issue 8, p47 

    The article discusses the findings of a retrospective review by Daryl C. Osbahr, which found that National Football League (NFL) players are able to return back to play faster following lateral ankle sprains than they are after syndesmosis sprains, which may prove more disabling.

  • Today's management of the acute ankle. Johnson, Robert J.; Stiell, Ian G.; Moyer, Paula // Patient Care;11/15/1997, Vol. 31 Issue 18, p118 

    Focuses on the treatment and diagnosis of ankle injuries. Use of the Ottawa ankle rule for patients 18 years old and older; How to distinguish sprains from strains; Information on treatment of common traumatic ankle injuries. INSET: RICE therapy.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics