Use of the ottawa ankle rule by paramedics in the outof. An ankle xray series is only required if there is any pain in the malleolar zone and. Ottawa ankle rules many trials evaluate the validity of the ottawa ankle rules oar for excluding fractures of the ankle in patients with an ankle sprain. Update on acute ankle sprains american family physician. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot. The ottawa ankle rule project demonstrated that more than 95% of patients with. Awareness and use of the ottawa ankle and knee rules in 5 countries. Implementation of the ottawa ankle rules the fourth paper addressed the implementation of the ottawa ankle rules and the impact of their implementation on clinical practice. Validation of the ottawa ankle rules in children with ankle injuries. Pmc free article plint ac, bulloch b, osmond mh, stiell i, dunlap h, reed m, tenenbein m, klassen tp.
Oct 10, 2016 the ottawa ankle rules, developed by stiell, specifies the criteria to be met before ordering xrays for a patient presenting with an acute ankle injury. The ottawa ankle rules oars are a valid clinical tool to determine the need for radiographs of the acutely injured ankle or midfoot. May 10, 2016 the rules, developed by emergency department physicians at the ottawa hospital and the university of ottawa, are applied to the ankle, knee or spine, and are evidencebased decision trees that. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. Synonyms for modified ottawa ankle rules in free thesaurus. It is the dedication of healthcare workers that will lead us through this crisis. The ottawa knee rules okrs were first derived and validated in ottawa, canada, with the aim of reducing the number of unnecessary radiographs ordered after knee trauma without compromising patient care.
Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. To summarize the evidence on accuracy of the ottawa ankle rules, a decision aid for excluding fractures of the ankle and midfoot. Modified ottawa ankle rules synonyms, modified ottawa ankle. Decision rules for the use of radiography in acute ankle injuries. The rules, developed by emergency department physicians at the ottawa hospital and the university of ottawa, are applied to the ankle, knee or. Rules have been prospectively validated on multiple occasions in different populations and in both children and adults. The ottawa knee rules were developed in an attempt to allow physicians to be more selective with radiography, without missing fractures.
Diagnosis historically imaging is ordered for most patients presenting with an ankle andor midfoot injury even though only about 15%. The ottawa rules for ankle, knee and spine now a mobile app. Ottawa ankle rules ottawa hospital research institute. A study to develop clinical decision rules for the use of radiography in acute ankle injuries from the departments of emergency medicine, ottawa civic hospital and ottawa general hospital. Ottaaw knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla.
National athletic trainers association position statement. The accuracy of the ottawa knee rule to rule out knee fractures. The rules have been demonstrated to decrease unnecessary diagnostic imaging and emergency room wait times which enhances patient comfort and reduces health care costs. The ottawa ankle rules show areas of tenderness to be evaluated in patients with ankle trauma to.
A knee xray is only required for knee injury patients with any of these findings. A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma. Ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf ottawa knee and ankle rules pdf download. Modified ottawa ankle rules synonyms, modified ottawa.
University of delaware open to the public physical therapy. Ankle sprains are a common occurrence in athletes as well as the general population. The ottawa ankle rule project demonstrated that more than 95% of patients with ankle injuries had radiographic examinations but that 85% of the films showed no fractures. Available at no cost, download the pdf files to your local printer for professional printing and laminating, or print from home or the office. Studies in which ottawa ankle rule was used to diagnose fractures of ankle or midfoot, possibility of constructing a 2x2 table specifying false positive and false negative rate. Thirteen percent 36274 patients presented fracture. Sensitivities range from the high 90100% range for clinically significant ankle and midfoot fractures, defined. A foot xray is required if there is any pain in the midfoot zone and any of these findings. The ottawa ankle rules oars aim to determine if a patient presenting with acute ankle or foot traumarelated pain requires plain radiographs of the. Applying the rules resulted in a relative reduction in ankle radiographs of 28% and in foot radiographs of 14%. Ottawa ankle rules an overview sciencedirect topics. The oar have been proven that their application reduces unnecessary radiography. Multi trial to introduce the ottawa ankle rule for the use of radiography in acute ankle injuries the fifth study assessed the feasibility and impact of. Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa.
Ottawa ankle rule in the evaluation for fractures in blunt. Ottawa rules regarding requirement for knee xray general. Ottawa ankle rules developed in 1992 by stiell goal. Implementation of the ottawa ankle rules by nurses working in an accident and emergency department. Ottawa knee and ankle rules pdf ottawa ankle and foot rules. The ottawa rules for ankle, knee and spine now a mobile.
Prospective validation of a decision rule for the use of radiography in acute knee injuries. Ottawa ankle rules xray for acute injury of the ankle or. Using the diagram below we can determine when an ankle series is required. Validation of the ottawa ankle rules in children with. The ottawa ankle rules and the buffalo modification of the ottawa rules should be judiciously applied to adult patients with ankle trauma to decrease the total number of ankle radiographs obtained the most important step in ankle fracture management is identifying stable verses unstable fractures. Ottowa ankle rules order form unc school of medicine. A foot xray series is only required if there is any pain the midfoot zone and. Objectives the purpose of this study was to assess the. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging. They have nearly perfect sensitivity for identifying clinically significant ankle fractures.
The rules appear on the front page of this document. Pdf validation of the ottawa ankle rules for acute foot and ankle. The ottawa ankle rules are used as a clinical prediction rule to rule out an ankle fracture in an acute situation without the need for an xray. The ottawa ankle rule was derived to aid efficient use of radiography in acute ankle and midfoot injuries. Ottawa ankle rules the ottawa hospital research institute. The objective of this study is to identify evidence of any level describing the use of the oar by. An ankle xray is required only if there is any pain in malleolar zone and any of these findings.
The ottawa ankle rules ankle fracture clinical prediction. Racgp the ottawa knee rules a useful clinical decision tool. The ottawa ankle rules show areas of tenderness to be evaluated in patients with ankle trauma to determine need for imaging. Background the ottawa ankle rules oar are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography.
Usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. Study to develop clinical decision rules for the use of. The ottawa ankle rules modified buffalo rule the buffalo rule was derived to increase the diagnostic accuracy of the ottawa ankle rules, with the point tenderness criterion directed to the crest or midportion of the malleoli distal 6 cm of the fibula and tibia, reducing the likelihood of palpating over injured ligament structures. The ottawa rules are a set of clinical decision rules developed by dr. Pdf most of the documents on the racgp website are in portable. The ottawa ankle rules determine the need for radiographs in acute ankle injuries. The above research led to a final set of decision rules, named the ottawa ankle rules, for the use of radiography in ankle injury. The ottawa ankle rules were established to help physicians decide which patients should have an xray following an acute ankle injury. Ankle radiography is indicated only if a patient has pain in the malleolar zone and any of the following findings. The ottawa ankle rules, developed by stiell, specifies the criteria to be met before ordering xrays for a patient presenting with an acute ankle injury. Multicentre trial to introduce the ottawa ankle rules for use of radiography in acute ankle injuries bmj 1995.
Ottawa ankle rules for the injured ankle pubmed central pmc. This screening tool was developed because of the need for a rapid and accurate way to avoid unnecessary imaging. Basketball season is back and with it comes a new season of early morning conditioning runs, late night pickup games, and of course, a few ankle sprains along the way. A group of ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. Xray requesting patterns before and after introduction of the ottawa knee rules in a uk emergency department. Emergency medicine research group, ottawa hospital research institute. Patient is at risk for recurrent ankle sprains and development of chronic ankle instability rule out fracture andor need for further imaging through utilization of the ottawa ankle rules exclude children under 6 or pregnant women bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus. The ottawa ankle rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. The behavioral intervention was the teaching of the ottawa ankle rules and feedback of compliance with the rules during the intervention. Ankle radiographs are suggested if there is pain in the malleolar region with any of the following. Stress radiography is an unreliable tool to detect acute ligamentous disruption after ankle sprain.
The ottawa ankle rules and subjective perception of foot andor ankle fractures were evaluated on the questionnaire. Ankle rules for ankle injury radiography a an ankle xray series is only required if there is any pain in malleolar zone and any of these findings. Questionnary to assess ankle and foot stiell ig, greenberg gh, mcknight rd, nair rc, mcdowell i, worthington jr. However, the prehospital experience in implementing this clinical decision rule appears poorly described. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. The ottawa ankle rules determine the need for radiographs in acute ankle. Clinical usefulness of the ottawa ankle rules for detecting fractures of the ankle and midfoot. The ottawa ankle rules are physical exam findings that help predict the likelihood of an osseous ankle injury. Pdf validation of the ottawa ankle rules for acute foot.
Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. The ottawa ankle rule was derived to aid in the efficient use. Ottawa ankle and foot rules an ankle xray is required only if there is any pain in malleolar zone and any of these findings. Jun 15, 2012 dowling s, spooner ch, liang y, et al. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Patients who do not meet the fracture predictor of the okrs are highly. No part of this publication may be reproduced in any format without written consent of eb medicine. Criteria ottawa knee rules xray for acute injury of the knee. The ottawa ankle rule oar is extensively documented in the emergency department setting and has been subjected to repeated validation. Racgp the ottawa knee rules a useful clinical decision.
Pdf application of ottawa ankle rules researchgate. Prospective evaluation of the ottawa ankle rules in a university sports medicine center. Pdf abstract ankle injury is a common injury sustained in an outdoor activity or as a sport injury presenting to the emergency department. Get a printable copy pdf file of the complete article 915k, or click on a. The ottawa ankle rules were initially devised to include age greater than 55 years as a criterion for radiography. Yes no for patients with acute trauma to the ankle bone tenderness at a bone tenderness at b inability to bear weight both immediately and in the ed an ankle radiographic series is only required if there is any pain in the malleolar zone and any of these. Usethe ottawa ankle rules oar to exclude fractures and reduce unnecessary imaging. The metaanalysis of bachmann, with a moderate risk of bias, summarizes the accuracy of the oar from 1990 to 2002. Accuracy of ottawa ankle rules to exclude fractures of the. Pdf the original and modified ottawa ankle rules oars were. Ottawa knee rule ottawa hospital research institute. Accuracy of ottawa ankle rules to exclude fractures of the ankle and midfoot in children. Aug 19, 2016 the ottawa ankle rules are used as a clinical prediction rule to rule out an ankle fracture in an acute situation without the need for an xray. Clinical value of the ottawa ankle rules for diagnosis of.