Tenderness of patella is significant only if an isolated finding. The ottawa ankle rules are guidelines indicating that xray studies should be obtained if there is pain in the malleolar zone and a bony tenderness at the distal 6 cm of the fibula or b bony tenderness at the distal 6 cm of the tibia or inability to take 4 steps immediately after injury. Cspine rule versus the nexus lowrisk criteria in patients with trauma. The amsterdam wrist rules are validated clinical decision rules for determining which patients require radiographic imaging wrist radiography for acute wrist pain following trauma. Decision rules for the use of radiography in acute ankle. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. Ankle injuries are extremely common but many features on history and physical examination are unreliable. First introduced in 1992 by stiell et al, the ottawa ankle rules were a guideline for caregivers after ankle trauma to determine whether or not an anklefoot xray was. Objectives the purpose of this study was to assess the. Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 3040%. Ottawa ankle rules an overview sciencedirect topics. They have nearly perfect sensitivity for identifying clinically significant ankle fractures.
The oar have been proven that their application reduces unnecessary radiography. 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. Bone tenderness at the posterior edge or tip of the medial malleolus b or. Implementation of the ottawa ankle rules jama jama network. The initial study evaluated 882 patients and were published in 2015 1. Sensitivity and specificity of oar were 100% and 77% respectively. Foot radiography is required if there is pain in the midfoot zone, and if one of the following is present. Unable to bear weight both immediately and in the emergency room department for 4 steps. The ottawa foot rule for the use of xray in foot injury calculator assesses the use of xray in foot injury. Since the publication of this study, the ottawa ankle rule have been well validated and have been shown to limit the number of radiographs obtained for ankle injuries, decreased patient wait times and cost. Validation of the ottawa ankle rules for acute foot and ankle injuries. Pdf validation of the ottawa ankle rules for acute foot.
The ottawa foot rules indicate that xrays should be obtained if there is pain in the midfoot. Specificities are approximately 41% for the ankle and 79% for the foot, though the rule is not designed or intended for specific diagnosis. To open a pdf file you will need compatible software such as adobe reader. Ottawa ankle rules ottawa hospital research institute. Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. The great lakes beachwalker case glass v goeckel, 473 mich 667. To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. The oar have been prospectively applied in several other studies 611 and in all. Pdf most of the documents on the racgp website are in portable document format pdf. An ankle xray series is only required if there is any pain in the malleolar zone and. Rigorous application of the oars have resulted in a 30% to 40% reduction in unnecessary xrays, while retaining nearly 100% sensitivity ottawa ankle rules, oar practice guidelines developed in canada in 1992 to reduce the number. Use of the ottawa ankle rule by paramedics in the outof.
Diagnostic performance of the bernese versus ottawa ankle rules. These rules were refined and validated prospectively on 453 patients 5. Ian stiell and his colleagues developed the ottawa ankle rules 1,2 to facilitate this decision. Ottaaw knee rule for knee injury radiography stiell ig, greenberg gh, wells ga, mcdowell i, cwinn aa, smith na, cacciotti tf, sivilotti mla. Ebscohost serves thousands of libraries with premium essays, articles and other content including use of the ottawa ankle rule by paramedics in the outofhospital setting. The ottawa ankle rule rules out clinically significant foot and ankle fractures to reduce use of xray imaging. A knee xray series is only required for knee injury patients with any of these findings. A clinical decision rule determining the need for xrays in patients with acute wrist trauma may help to percolate and select patients with fractures. A set of guidelines to help doctors decide if a patient with foot or ankle pain should be xrayed to rule out bone fracture. Firefighters pulled three people from a burning home in the britannia beach area early monday morning but they were without vital signs as they were rushed to the hospital. Radiographic examinations showed 19 fractures out of 100 investigated patients table 1. These files will have pdf in brackets along with the filesize of the download. Ottowa rules definition of ottowa rules by medical. A clinical decision rule to determine the need for diagnostic imaging for ankle andor foot trauma.
Diagnostic performance of the bernese versus ottawa ankle. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments. Ottawa knee rule ottawa hospital research institute. Board of commissioners that are within its exclusive jurisdiction, or heard at a work session and which are forwarded to the board of commissioners for consideration, shall be placed on the agenda and heard at the next scheduled meeting of the board of commissioners, or at the following meeting, as may be determined by the chairperson. These patients are routinely referred for radiological examination. The ottawa sah rule was developed for use in an emergency department setting in patients presenting with acute headache. A foot xray is required if there is any pain in the midfoot zone and any of these findings.
The combined ottawa ankle and foot rules have a sensitivity of 97. Background the ottawa ankle rules oar are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The decision rules assessed different clinical parameters that increase the likelihood of either a distal radial fracture or any wrist fracture. Implementation of the ottawa ankle rules led to a decrease in use of ankle radiography, waiting times, and costs without patient dissatisfaction or missed fractures. Ottawa neck rules pdf for alert gcs15 and stable trauma patients where cervical spine injury is a concern. Clinical value of the ottawa ankle rules for diagnosis of. Comparison of ottawa ankle rules and bernese ankle rules in acute ankle and midfoot injuries injury during daily walking, and the remaining reported other reasons. Future studies should address the generalizability of these decision rules in a variety of. Proportion of perfect knowledge of the ottawa ankle and foot rules time frame. Ottawa foot rule for the use of radiographs in foot injury. City of nottawa, mi saint joseph county michigan zip codes.
Bone tenderness at the posterior edge or tip of the lateral malleolus a or. Should only be used in patients who are alert and oriented, presenting within 14 days of headache, without history of head trauma or fall in the past 7 days. Evidence supports the ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and midfoot. The ottawa ankle and foot rules to image or not to image. Comparison of ottawa ankle rules and bernese ankle rules. A clinical decision rule to determine the need for diagnostic imaging for knee trauma. Water law and michigan townships the 2011 annual michigan townships association convention in grand rapids, michigan wednesday, january 26, 2011 3.
Ottawa subarachnoid hemorrhage sah rule for headache. It is the dedication of healthcare workers that will lead us through this crisis. Ottawa ankle rules to exclude fractures of ankle and midfoot. Use of the ottawa ankle rule by paramedics in the outofhospital setting introduction the ottawa ankle rule oar is extensively documented in the emergency department setting and has been subjected to repeated validation. Key recommendations usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. The ottawa knee rule describes criteria for minor knee trauma patients that are so low risk as not to warrant knee imaging. Unable to transfer weight twice onto each lower limb regardless of limping. An inability to bear weight both immediately and in the emergency department for four steps. Racgp the ottawa knee rules a useful clinical decision. Using the ottawa ankle rules, xray imaging can be reduced 34% for the ankle series and 30% for the foot series. The parameters used in the calculator include pain in the foot, inability to bear weight right after the injury as well as in the emergency department, and bone. The ottawa ankle rule is useful for ruling out fracture high sensitivity, but poor for ruling in fractures many false positives.