Decision rules for the use of radiography in acute ankle injuries: refinement and prospective validation

Article Abstract:

Following the Ottawa ankle rules in deciding when to use radiography for ankle and foot injuries may be effective both in detecting fractures and reducing the number of unnecessary x-rays. About five million ankle x-rays are ordered every year in Canada and the US, but fractures are present in only about 15% of the cases. The refined Ottawa rules say ankle x-rays are needed only if there is pain near the ankle joint and if there is bone tenderness or an inability to bear weight. The rules for foot x-rays are the same for pain in the midfoot. Of 1,032 patients who underwent radiography, all 121 with ankle fractures and 48 of 49 patients with foot fractures were correctly identified following the original Ottawa rules. Of 453 patients who were then evaluated according to the refined Ottawa rules, all 50 patients with ankle fractures and all 19 patients with foot fractures were correctly identified. Full implementation of the refined rules would have safely reduced the number of ankle x-rays by 34% and foot x-rays by 30%.

Ankle, Ankle injuries, Radiography, Medical, Medical radiography

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Prospective validation of a decision rule for the use of radiography in acute knee injuries

Article Abstract:

A decision rule that includes information about specific physical signs and symptoms in people with knee injuries may reduce the need for an X-ray. Researchers tested a decision rule in 1,096 people who presented to an emergency department with a suspected knee injury. According to the rule, people older than 55 who have tenderness at or around the knee, cannot bend their knee to 90 degrees and cannot put weight on the leg are more likely to have a knee fracture. The rule identified all 63 fractures that were subsequently confirmed by X-ray. It also identified half of the non-fractures that would not have required an X-ray. The emergency physicians correctly interpreted the rule 96% of the time and there was high agreement between different physicians. An estimated 1.3 million people are X-rayed for possible knee injuries each year, and more than 92% of the X-rays are negative. The use of this decision rule could substantially reduce the costs associated with unnecessary X-rays.

Economic aspects, Knee injuries, Diagnosis, Radioscopic, Radioscopic diagnosis, Decision tables, Decision logic tables

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Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries

Article Abstract:

The Ottawa Knee Rule appears to be capable of detecting a knee fracture without X-rays, thereby sparing the expense of an X-ray in patients who don't have a fracture. The rule assesses certain physical findings, including pain in the knee and the inability to flex the knee or bear weight. Researchers assessed 3,907 adults suspected of knee fracture for a 12-month period before and after the rules were implemented. Use of the rules reduced the order rate for X-rays by 26%. The rules accurately detected all 58 knee fractures subsequently found on X-ray. They reduced total health care costs as well as time spent in the emergency department.

Evaluation, Diagnosis, Fractures (Injuries), Fractures, Medical protocols

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