Implementation of the Ottawa Ankle Rules in France
Studies in canada that employ the Ottawa Ankle Rules (OAR) have resulted in as much as a 24-26% reduction in x-rays of traumatized ankles. Whether similar results can be anticipated in other populations has been unclear. The OAR are suggest that x- rays are indicated for an ankle if there is malleolar pain combined with 1) bone tenderness at the posterior edge or tip of the lateral malleolus; 2) bone tenderness at the posterior edge or tip of the medial malleolus; or 3) inability to bear weight both immediately and in the emergency department. A similar set of rules exists for foot radiographs.
Six Paris university teaching hospitals provided 1911 study subjects who had sustained recent (< 10 days prior) ankle or midfoot injury; of these, 906 were managed by clinicians who had been instructed in the principles and use of the OAR. Additionally, intervention patients had pre-printed checklists of the OAR placed on their charts prior to being seen by the clinician. Physicians were allowed to choose whether they wished to obtain x-rays (regardless of the OAR results).
During the intervention period, there was a 22% decrease in requests for radiography among the intervention group (P < 0.05); at the same time, the control group experienced a 0.5% increase in radiology requests. This study indicates that implementation of the OAR can produce comparable reductions in radiographic examinations to those enjoyed in the institution of origin.
Auleley G-R, et al. JAMA 1997;277: 1935-1939.
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