Implementation of the Ottawa Ankle Rules in France
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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