How Good Are Ankle Rules for Determining If a Patient Needs An X-Ray?
This study supports that if the clinical examination indicates a low risk injury, then radiographs are not indicated. If the examination indicates a potential high risk injury, then the radiographs would be indicated because the clinical examination cannot discern well enough if a fracture is present or not.
Use of the Low Risk Ankle Rule was evaluated in a Canadian study of 3-16 year old children. The study found a decrease in radiographs by 22% using the Low Risk Ankle Rules. Overall the sensitivity was 100% and the specificity was 53.1%.
This study supports that if the examination indicates a low risk injury, then radiographs are not indicated. Fractures that were missed in the low risk group (i.e. false negatives) were low risk fractures that were treated like ankle sprains. If the examination indicated a potential high risk injury, then the radiographs would be indicated because the clinical examination cannot discern well enough if a fracture is present or not.
This group also found cost savings of $37 Canadian dollars per patient.
While most of the studies using these ankle rules are in emergency departments or physician offices some time period after the injury, similar data has been shown for athletic trainers treating acute (<1 hour after injury) ankle injuries.
In this study, which utilized the Ottawa Ankle Rules, it is understandable that the need for radiographs was overestimated (i.e. false positive clinical examination) because of increased pain, guardin...
Source: PediatricEducation.org - Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news
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