ottawa ankle rules sensitivity specificity
However, the Ottawa rules were more sensitive than clinical suspicion alone. Results —Nine ankle and eight midfoot fractures were detected. We often think of sensitivity and specificity as being ways to indicate the accuracy of the test or measure. Values are percentages Category Sensitivity (95% CI) Median specificity (interquartile range) All studies (n=39) 97.6 (96.4 to 98.9) 31.5(23.8-44.4) Type of . By Federico G Capriles FACP. The Ottawa Ankle Rule(s) are effective in determining when an x-ray is warranted. ankle injuries are extremely common but many features on history and physical examination are unreliable the combined ottawa ankle and foot rules have a sensitivity of 97.8% and a specificity of 31.5%, giving a negative likelihood ratio of 0.07; this will yield a post-test probability of about i % for fracture of the ankle if test results are … Prior to the creation of the Ottawa Ankle Decision Instrument, most patients presenting to the Emergency room with a complaint of acute ankle injury had ankle and or foot radiographs ordered to evaluate for fracture, even though the incidence of fracture among this population is relatively low (~ 15%). The objective of this work was in the first place to validate the Ottawa Ankle Rules (OARs) for the population of our centre. The sensitivity of the ankle portion of the rule, as applied by NPP's, was 88% (47-99 CI) and the specificity was 31% (23-40% CI) for clinically significant fractures. FOAM Topics on Emergency Medicine. Tenderness at posterior edge or tip of lateral malleolus OR. measures were: sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios (positive and negative) of the OARs. The Ottawa ankle rules have been validated in adults with 100% Sensitivity. The Ottawa Ankle Rules (OAR) are a set of clinical decision rules that were derived and validated by Stiell et al. Sensitivity 100%, Specificity 49% in validation cohort; Foot Rules Sensitivity 98%, Specificity 70% in refinement cohort; Sensitivity 100%, Specificity 79% in validation cohort . There were six clinically significant ankle fractures and three midfoot fractures, for a total incidence of 5.8%. We found a sensitivity of OARs in ankle injuries of 100%, specificity of 26% and in midfoot injuries of 100% and 62% respectively. In medicine, the Ottawa ankle rules are a set of guidelines for clinicians to help decide if a patient with foot or ankle pain should be offered X-rays to diagnose a possible bone fracture. Emerg Med J. The method used was the evaluation of the patients by the nurses and the residents who had stayed in the area for three years. No evidence was found in favour of the use of magnetic resonance imaging (MRI) or computed tomography (CT) in the acute phase of ankle sprain. Some points to consider when carrying the assessment: Palpate . Ankle injuries are extremely common but many features on history and physical examination are unreliable The combined have a sensitivity of 97.8% and a specificity of 31.5%, giving a negative likelihood ratio of 0.07; this will yield a post-test probability of about 1% for fracture of the ankle if test results are negative (not requiring x ray) Results: The study recruited 175 patients over a six month period. The Ottawa ankle rules have a high sensitivity for excluding fractures of the ankle and midfoot in acute ankle sprain Free Robert H Fletcher, MD, MSc http://dx.doi.org/10.1136/ebm.8.6.185 Statistics from Altmetric.com See more details Referenced in 1 policy sources 11 readers on Mendeley Request Permissions (2003) BMJ 326, 417. "Plain radiographs of the knee are among the most commonly ordered radiographs in U.S. emergency departments; 60% to 80% of patients with knee pain have . Ottawa Ankle Rule Derivation Ankle (n=750) • • • Sensitivity Specificity NPV PPV X-ray reduce 100% 40% 100% 16% 36% Foot (n=750) • • • Sensitivity Specificity NPV PPV X-ray reduce 100% 25% 100% 18% 21% Stiell et al. This screening tool was developed because of the need for a rapid and accurate way to avoid unnecessary imaging. Fig 1 Ottawa ankle rules Table 2 Pooled sensitivity (bootstrapped) and distribution of specificity in 27 studies (39 2x2 tables) of Ottawa ankle rules in diagnosis of ankle fractures. Conclusion: The Ottawa Ankle Rules are the most sensitive test for detecting significant ankle fracture in patients . While ankle radiographs do not expose the patient to large amounts of radiation,<br/><a . For physical therapists, the sensitivity was 100%, the specificity for ankle injuries was 40%, and the specificity for foot injuries was 79%. Evidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. A previous best evidence topic report examined whether these rules could be applied to children.1 At that time there was insufficient evidence to make a determination. Conclusion We were unable to validate with 100% sensitivity the Ottawa rules predicting ankle and midfoot fractures. The Ottawa Ankle rules were applied and x-rays were obtained when the expert saw a need for one. (Garcia, 2004, p. In this study, it was found to have a sensitivity of 100 percent and is therefore unlikely to miss clinically significant ankle and midfoot injuries. Ottawa Ankle Rules This guideline will aid you in determining which patients require an x-ray of their ankle. wanted to build on the small literature base surrounding the sensitivity and specificity of non physician providers' using the Ottawa Ankle Rules applied to . The results were a 96% sensitivity rate and specificity of 6%. The Ottawa Foot and Ankle Rules (OFAR) were designed to obviate the need for unnecessary x-rays. the ottawa ankle and midfoot rules are the most commonly used clinical prediction rules to identify patients with a low probability of ankle and midfoot injuries that do not require radiographic examination. The Ottawa Ankle Rules are commonly used clinical examination rules to identify patients with ankle injuries that do not require radiographic examination [13]. The Ottawa Ankle Rules (OAR) first were introduced by Ian Stiell, et al in 1993. The Ottawa ankle rules presented 97.2% sensitivity, 7.8% specificity, 13.9% positive predictive value, 95% negative predictive value and 19.9% accuracy respectively. The Ottawa Ankle Rules (OARs) have been designed to reduce the number of unnecessary radiographs ordered for these patients. In children ages 1-15 the Ottawa Ankle rules have been validated with 98-100% Specificity and 36-47% Sensitivity for clinically significant ankle injuries, however other studies have suggested lower sensitivity rates. Key words: ankle injuries; Ottawa ankle rule; sen-sitivity; specificity; decision support technique Abstract Clinical decision aids aim to guide diagnosis or treatment by integrating a small set of easily accessible clinical information. Ottawa ankle rule. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40%. The ankle component of the OAR states that radiographic evaluation of the ankle is only necessary if there is pain in the malleollar zone and one of the . . The OAR met this goal with an associated specificity of 40% (i.e., the clinician will still . Table 1 shows the calculations for a cohort of 1,000 persons, in whom there were 100 actual fractures, applied to the best, average, and worse specificity values found in the review. 6 the rules state that patients should be referred for radiographic examination or other medical imaging if they have pain in the malleolar … 2 MacLellan et al. The seven studies, conducted in university and community hospital EDs, had examined the sensitivity, specificity, and positive and negative predictive values of the Ottawa ankle rules. Inability to bear weight immediately and in the ED (4 steps) OR. Actions. Forty fractures (21%) were identified. Prospective evaluation of the Ottawa Ankle Rules in a university sports medicine center: with a modification to increase specificity for identifying malleolar fractures. Evidence . Ankle and Midfoot Rules presented similar accuracies, which were homogeneous and high for sensitivity and negative likelihood ratios and poor and heterogeneous for specificity and positive likelihood ratios (mean, 95% CI pooled sensitivity of Ankle Rules: 99.4%, 97.9% to 99.8%; specificity: 35.3%, 28.8% to 42.3%). Ankle and Midfoot Rules presented similar accuracies, which were homogeneous and high for sensitivity and negative likelihood ratios and poor and heterogeneous for specificity and positive likelihood ratios (mean, 95% CI pooled sensitivity of Ankle Rules: 99.4%, 97.9% to 99.8%; specificity . These rules is validated in both adults and children. . For both the Ottawa and the Leiden ankle rules, we calculated the sensitivity, specificity, percentage of In the clinical setting, screening is used to decide which patients are more likely to have a condition. Sensitivity and specificity of the Ottowa ankle rules range from 92-100% and from 16-51%, respectively. Ottawa ankle rules sensitivity specificity Diagnostic Accuracy of the Ottawa Ankle and Midfoot Rules . Implementation of the Ottawa Ankle Rules in a university sports medicine center. Daş et al. Am J Sports Med. True negative b. (Garcia, 2004, p. Several studies strongly support the use of the Ottawa Ankle Rules in children over 6 (98.5% sensitivity); however, their usefulness in younger children has not yet been thoroughly examined. The radiographic series was used as the ref-erence standard. All patients with fractures had a VAS of 5 or more points in any of the tested sites. published, the Ottawa ankle rule was said to have 100% sensitivity & 40% specificity for detecting ankle fractures.1Therefore, all patients who truly had a fracture would still get a radiograph, but a good many who did not have fractures would be weeded out -36% by the investigators estimate1.However subsequent independent studies2 3,4reported . ACEP International Member; SEMES Certificado; EuSEM Member. The Adobe Flash plugin is needed to view this content. PPT - Journal Reading Topic: Ottawa Ankle Rules PowerPoint presentation | free to view - id: 7ad39-Nzk3Y. 1998;26(2):158-165. In subsequent prospective validation of the Ottawa Ankle Rules in various settings (emergency departments, community-based clinics, primary care . The mean age of patients was 12.6 years. Data collected was entered into a data sheet and analysed for sensitivity, specificity, positive and negative predictive values when using the Ottawa ankle rules. Acute ankle injuries are one of the most common reasons for presenting to emergency departments, but only a small percentage of patients - approximately 15% - have clinically significant fractures. The results were a 96% sensitivity rate and specificity of 6%. The overall specificity was 31.5 percent (95 percent CI, 23.8 to 44.4), with the lowest specificities in children and combined fractures. Validation of the Ottawa ankle rules in a second-level trauma center in Italy Received: 11 October 2006 . Conclusion: Evidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The Buffalo Rule is reported to result in a 54% reduction in radiography costs. Leddy JJ, Kesari A, Smolinski RJ. There were not enough studies to allow comparison according to setting of application. The Ottawa ankle rules (OAR) are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. 1 Stiell's goal was a rule with 100% sensitivity for clinically significant fractures (> 3 mm fracture fragment), while not missing any clinically important fractures. 1998;26(2):158-165. Hospital Universitario Sant Joan de Reus. Specificity was higher for Midfoot than for Ankle Rules. Decision rules had sensitivity of 94.6% and specificity of 15.5% for ankle fractures and sensitivity of 93.1% and specificity of 11.5% for midfoot fractures. average sensitivity (99.4%), nevertheless have relatively low average specificity values (35.3%), not allowing the exclusion of imaging tests of a large number of patients. Specificity represents the number of patients without the condition and CONCLUSIONS: Evidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. Although these rules have been determined to be very sensitive, they lack the specificity necessary to make them practically useful for a condition in which a misdiagnosis could result in a . 2001;18:466-7. Sensitivity The use of the Ottawa Ankle Rules by physicians has reduced radiography, time spent in the ED, healthcare expenditures, while not missing clinically relevant fractures. The sensitivity of the Ottawa ankle rules protocol in predicting fractures in both the malleolar and midfoot zones was 100%. Sensitivity and specificity of the Ottawa ankle rules There were 11 cases of disagreement between the reviewing practitioners when surveying the data sheets for Ottawa status that were resolved by a third practitioner. Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR. Implementation of the Ottawa Ankle Rules in a university sports medicine center. The OAR have been proven that their application reduces unnecessary radiography. The Ottawa ankle rules in children. The only clinically significant fracture missed by NPP's was detected on physician assessment. The Ottawa Ankle rules were applied and x-rays were obtained when the expert saw a need for one. Annals EM 1992 While ankle radiographs do not expose the patient to large amounts of radiation,<br/><a . The ankle component of the OAR states that radiographic evaluation of the ankle is only necessary if there is pain in the malleollar zone and one of the . The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40%. Results. The Ottawa ankle rules have been validated in adults with 100% Sensitivity. "Bearing weight" counts even if the patient limps. This appraisal updates that topic. However, these patients are almost always referred for radiography. Implementation of the Ottawa ankle rules by general practitioners in the emergency department of a Turkish district hospital with a positive test. The OAR have been proven that their application reduces unnecessary radiography. [14] For this reason, an OAR (-) finding is a reasonable indication that no fracture is present. Leddy JJ, Kesari A, Smolinski RJ. Keywords: Ankle, Bernese Ankle Rules; foot; fracture; Ottawa Ankle Rules. A pooled analysis was conducted of the seven studies on the clinical diagnostic effectiveness of the Ottawa ankle rules when used with adult patients in the emergency department (ED). Rule had 100% sensitivity and 49% specificity for identifying 50 clinically significant . Sensitivity, specificity, and the positive predictive value were calculated in 153 patients. Tenderness at posterior edge or tip of medial malleolus. For each patient, the scores for the Ottawa and Leiden ankle rules were calculated from the relevant variables on the structured data collection form. Objectives The Ottawa ankle rule is an effective tool to determine the use of radiography for acute ankle injuries. Yuen Man-Cheuk. Differentiating the severity of acute ankle injuries is a common problem in the emergency department (ED). They have nearly perfect sensitivity for identifying clinically significant ankle fractures. The Ottawa ankle rules are a clinical instrument calibrated towards a high sensitivity in order not to miss any fractures of the ankle or mid-foot. Sensitivity, specificity and receiver operating characteristic curve of Ottawa ankle rule items and subjective perception of the orthopedic surgeon concerning fracture occurrence Source publication The Ottawa ankle rule is an excellent screening tool for patients with ankle and foot injuries. Abstract Objective: The purpose of this study was to compare the sensitivity and specificity of Ottawa Ankle Rules (OAR) and Bernese Ankle Rules (BAR) in acute ankle and midfoot injuries in the emergency department. In children ages 1-15 the Ottawa Ankle rules have been validated with 98-100% Specificity and 36-47% Sensitivity for clinically significant ankle injuries, however other studies have suggested lower sensitivity rates. This is at the cost of a mean specificity of around only 32%. Prospective criteria failed to predict fracture in five of the ankle group and two of the midfoot group. Sec- Leddy JJ, Smolinski RJ, Lawrence J, Snyder JL, Priore RL. In 1992 a group of Canadian physicians created a set of rules, called the Ottawa ankle rules,6 which can be used by the . Exclusions • Less than 18 years old • Intoxication • Multiple painful injuries • Pregnant • Head injury • Diminished sensation due to neurological deficit Recommendations Background:The Ottawa ankle rules (OAR) are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The prototype ex-ample for such a decision aid is the Ottawa Ankle Rule (OAR) [1] to reduce the number of . False negative c. True positive d. False positive 4) The sensitivity of a test is: a. Get the plugin now. Before the introduction of the rules most patients with ankle injuries would have been imaged. The Ottawa ankle and foot rules were designed to minimise the number of radiographs needed. There are two components, assessing for ankle and midfoot fractures. The Ottawa ankle rules are a clinical decision-making strategy for determining which patients require radiographic imaging for ankle and midfoot injuries.Proper application has high (97.5%) sensitivity and reduces the need for radiographs by ~35% 1,2,4.. An Ankle X-ray is only required if: There is any pain in the malleolar zone; and, Any one of the following: Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR. The Ottawa ankle rules are a clinical instrument calibrated towards a high sensitivity in order not to miss any fractures of the ankle or mid‐foot. . Specificity was estimated to be 0.3 for ankle fractures and 0.4 for midfoot fractures.
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