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Use of the Ottawa Ankle Rules in children: a survey of physicians’ practice patterns

Published online by Cambridge University Press:  11 May 2015

Shawn K. Dowling  and
Ian Wishart
Shawn K. Dowling*
Affiliation:
Department of Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB
Ian Wishart
Affiliation:
Department of Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB
*
Department of Emergency Medicine, University of Calgary, North Hill Centre 32, Unit 1633, 1632-14th Avenue, NW, Calgary, AB T2N 1M7; skdowling@gmail.com

Abstract:

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Introduction:

A number of studies have assessed the diagnostic accuracy of the Ottawa Ankle Rules (OAR) in children; however, the role of the OAR in guiding physician radiograph use is unclear.

Objectives:

The primary purpose of this study was to determine the extent to which Canadian pediatric emergency physicians report using the OAR. Secondary goals included determining current diagnostic and management strategies for Salter-Harris 1 (SH-1) injuries of the ankle and which fractures physicians deem to be clinically significant.

Methods:

A self-administered piloted survey was distributed by mail to 215 Canadian pediatric emergency physicians using a modified Dillman technique. Participants were selected through Pediatric Emergency Research Canada (PERC), a national network of health care professionals with an interest in pediatric emergency medicine research.

Results:

Of 209 surveys, 144 were returned, for a response rate of 68.9%. Of those, 87.5% (126 of 144) reported applying the OAR in children to determine the need for radiographs in acute ankle or midfoot injuries. Of those, 65.1% reported using the OAR always or usually, and 64.5% (93 of 144) of physicians stated that they believe all ankle fractures are clinically significant. Although physicians report that they most commonly order the radiographs, 36.2% of participants indicated that radiographs were requisitioned by nurses or other health care providers at their facilities. SH-1 fractures were reported to be most commonly managed by immobilization (83.3%; 120 of 144), with most patients going on to follow-up with an orthopedic surgeon.

Conclusions:

The majority of Canadian pediatric emergency physicians indicate that they use the OAR when assessing children with acute ankle and midfoot injuries. Most physicians believe that all ankle fractures, including SH-1, are clinically significant and have a management preference for immobilization and orthopedic follow-up.

Keywords

Ottawa Ankle Rulespediatricspractice patternsSalter-Harris fractures
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 5 , September 2011 , pp. 333 - 338
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Vargish, T, Clarke, WR, Young, RA, Jensen, A. The ankle injury-indications for the selective use of x-rays. Injury 1983;14:507–12.CrossRefGoogle ScholarPubMed
2.Clark, KD, Tanner, S. Evaluation of the Ottawa ankle rules in children. Pediatr Emerg Care 2003;19:73–8, doi:10.1097/ 00006565-200304000-00003.CrossRefGoogle ScholarPubMed
3.Boutis, K, Komar, L, Jaramillo, D, et al. Sensitivityofa clinical examination to predict need for radiography in children with ankle injuries: a prospective study. Lancet 2001; 358:2118–21, doi:10.1016/S0140-6736(01)07218-X.CrossRefGoogle ScholarPubMed
4.Stiell, IG, Greenberg, GH, McKnight, RD, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA 1993;269: 1127–32, doi:10.1001/jama.269.9.1127.CrossRefGoogle ScholarPubMed
5.Anis, AH, Stiell, IG, Stewart, DG, Laupacis, A. Cost-effectiveness analysis of the Ottawa Ankle Rules. Ann Emerg Med 1995;26:422–8, doi:10.1016/S0196-0644(95) 70108-7.Google Scholar
6.Al Omar, MA, Baldwin, GA. Reappraisal of use of x-rays in childhood ankle and midfoot injuries. Emerg Radiol 2002;9:88–92.Google Scholar
7.Chande, VT. Decision rules for roentgenography ofchildren with acute ankle injuries. Arch Pediatr Adolesc Med 1995;149:255–8.Google Scholar
8.Cuello-Garcia, C, Ruiz-Flores, A, Ramos-Gomez, L, Medina-Lopez, ME. The Ottawa ankle rules: evaluation in a pediatric emergency setting in Mexico. Anales De Pediatria 2004;60: 454–8, doi:10.1157/13059649.Google Scholar
9.Karpas, A, Hennes, H, Walsh-Kelly, CM. Utilization of the Ottawa ankle rules by nurses in a pediatric emergency department. Acad Emerg Med 2002;9:130–3, doi:10.1111/ j.1553-2712.2002.tb00229.x.CrossRefGoogle Scholar
10.Libetta, C, Burke, D, Brennan, P, Yassa, J. Validation of the Ottawa ankle rules in children. J Accid Emerg Med 1999;16:342–4.CrossRefGoogle ScholarPubMed
11.McBride, KL. Validation of the Ottawa ankle rules. Experience at a community hospital. Can Fam Physician 1997;43:459–65.Google Scholar
12.Plint, AC, Bulloch, B, Osmond, MH, et al. Validation of the Ottawa Ankle Rules in children with ankle injuries. Acad Emerg Med 1999;6:1005–9, doi:10.1111/j.1553-2712.1999. tb01183.x.CrossRefGoogle ScholarPubMed
13.Dohin, B, Lubanziado, D. Validation of the Ottawa Ankle Rules for varus ankle trauma in children: A prospective study of 160 cases. 2004. J Bone Joint Surg - British Volume 2002;86(Supp 20).Google Scholar
14.Dowling, S, Spooner, CH, Liang, Y, et al. AccuracyofOttawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med 2009;16:277–87. Epub 2009 Feb 2, doi:10.1111/j.1553-2712.2008.00333.x.CrossRefGoogle ScholarPubMed
15.Dillman, DA. Mail & Internet Surveys: the Tailored Design Method. New York: John Wiley & Sons; 2000.Google Scholar
16.Runyon, MS. Can we safely apply the Ottawa Ankle Rules to children? Acad Emerg Med 2009;16:352–4.Google Scholar
17.Dias, LS, Tachidjian, MO. Physeal injuries of the ankle in children. Clin Orthop 1978;136:230–3.Google Scholar
18.Gleeson, AP, Stuart, MJ, Wilson, B, Phillips, B. Ultrasound assessment and conservative management of inversion injuries of the ankle in children: plaster of Paris versus Tubigrip. JBoneJoint Surg 1996;78B:484–7.Google ScholarPubMed
19.Launay, F, Barrau, K, Petit, P, et al. Ankle injuries without fracture in children. Prospective study with magnetic resonance in 116 patients. Rev Chir Orthop Reparatrice Appar Mot 2008;94:427–33.CrossRefGoogle ScholarPubMed
20.Boutis, K, Willan, AR, Babyn, PI, et al. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics 2007;119: e1256-63, doi:10.1542/peds.2006-2958.CrossRefGoogle ScholarPubMed