Skip to main content
NCBI home page
Atencion Primaria logoLink to Atencion Primaria
. 2013 Apr 5;28(2):129–135. [Article in Spanish] doi: 10.1016/S0212-6567(01)78913-5

Reglas del tobillo de Ottawa: análisis de su validez como reglas de decisión clínica en la indicación de radiografías en los traumatismos de tobillo y/o medio pie

The Ottawa ankle guidelines: analysis of their validity as clinical decision guidelines in the indications of x-rays for ankle and/or middle-foot traumas

P Garcés a,d,*, S Gurucharri b,e, C Ibiricu a,e, ME Izuel a,e, JA Mozo c,d, P Buil b, J Díez a
PMCID: PMC7677950  PMID: 11440651

Abstract

Objective

To analyse the validity of the Ottawa ankle guidelines (OAG) as clinical decision guidelines in the indications of X-rays for ankle and/or middle-foot traumas in primary care.

Design

Observational, with application of the OAG and prospective measurement of the results.

Setting

Hospital casualty.

Patients

Adults who attended casualty for ankle or middle-foot traumas between 1st June 1999 and 31th March 2000. Criteria for exclusion were: under 18, pregnancy, grave sensory and/or awareness disturbances, multi-trauma or multi-contusion patients, traumas over a week old, skin lesions as side-effects of the trauma, X-ray in other department, high inflammation or oedema hindering palpation of bone protuberances.

Measurements

Application of the OAG and X-ray on all patients, regardless of the result of the OAG. Calculation of sensitivity, negative predictive value, specificity and positive predictive value.

Results

56 of a sample of 494 patients had a fracture (11.34%), 34 in the malleolus area (6.9%) and 22 in the middle-foot area (4.44%). OAG sensitivity was 96.43% (95% CI, 94.8-98). Negative predictive value was 97.22% (95.77-98.67). Specificity was 15.98% (12.75-19.21), and positive predictive value was 12.8% (9.86-15.74).

Conclusions

The OAG are valid in primary care as guidelines to decide whether to request X-rays for patients with ankle or middle-foot traumas.

Key words: Ottawa guidelines, Clinical decision guidelines, Ankle traumas

Bibliografía

  • 1.Garrick J.M. The frequency of injury, and epidemiology of ankle sprains. Am J Sports Med. 1977;5:241. doi: 10.1177/036354657700500606. [DOI] [PubMed] [Google Scholar]
  • 2.Holmer P., Sondergaard L., Konradsen L., Nielsen P.T., Jorgensen L.N. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int. 1994;15:72–74. doi: 10.1177/107110079401500204. [DOI] [PubMed] [Google Scholar]
  • 3.Sondergaard L., Konradsen L., Holmer P., Jorgensen L.N., Nielsen P.T. Acute midtarsal sprains: frequency and course of recovery. Foot Ankle Int. 1996;17:195–199. doi: 10.1177/107110079601700402. [DOI] [PubMed] [Google Scholar]
  • 4.Wedmore I.S., Charette J. Emergency department evaluation and treatment of ankle and foot injuries. Emerg Med Clin North Am. 2000;18:85–113. doi: 10.1016/s0733-8627(05)70109-7. [DOI] [PubMed] [Google Scholar]
  • 5.Wesler R.K. The injured ankle. Am Fam Phys. 1998;57:474–480. [PubMed] [Google Scholar]
  • 6.Salcedo I., Sánchez A., Carretero B., Herrero M., Mascías C., Panadero F.J. Esguince de tobillo. Valoración en atención primaria. Med Integral. 2000;36 doi: 10.1016/S0212-6567(00)78623-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Stiell I.G. Ottawa ankle rules. Can Fam Physician. 1996;42:478–480. [PMC free article] [PubMed] [Google Scholar]
  • 8.Dunlop M.G., Beattie T.F., White G.K., Raab G.M., Doull R.I. Guidelines for selective radiological assessment of inversion ankle injuries. BMJ. 1986;293:603–605. doi: 10.1136/bmj.293.6547.603. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Stiell I.G., Greenberg G.H., Mcknight R.D., Nair R.C., McDowell I., Worthington J.R. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21:384–390. doi: 10.1016/s0196-0644(05)82656-3. [DOI] [PubMed] [Google Scholar]
  • 10.Stiell I.G., McDowell I., Nair R.C., Aeta H., Greenberg G., Mcknight R.D. Use of radiography in acute ankle injuries: physicians’ attitudes and practice. Can Med Assoc J. 1992;147:1671–1678. [PMC free article] [PubMed] [Google Scholar]
  • 11.McBride K.L. Validation of the Ottawa ankle rules. Experience at a community hospital. Can Fam Physician. 1997;43:459–465. [PMC free article] [PubMed] [Google Scholar]
  • 12.Stiell I.G., Greenberg G.H., Mcknight R.D., Nair R.C., McDowell I., Reardon M. Decision rules for the use of radiography in acute ankle injuries: refinement and prospective validation. JAMA. 1993;269:1127–1132. doi: 10.1001/jama.269.9.1127. [DOI] [PubMed] [Google Scholar]
  • 13.Stiell I.G., Mcknight R.D., Greenberg G.H., McDowell I., Nair R.C., Wells G.A. Implementation of the Ottawa ankle rules. JAMA. 1994;271:827–832. [PubMed] [Google Scholar]
  • 14.Stiell I.G., Wells G., Laupacis A. Multicentre trial to introduce clinical decision rules for the use of radiography in acute ankle injuries. BMJ. 1995;311:594–597. doi: 10.1136/bmj.311.7005.594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Auleley G.R., Kerboull L., Durieux P., Cosquer M., Courpied J.P., Ravaud P. Validation of the Ottawa ankle rules in France: a study in the surgical emergency department of a teaching hospital. Ann Emerg Med. 1998;32:14–18. doi: 10.1016/s0196-0644(98)70093-9. [DOI] [PubMed] [Google Scholar]
  • 16.Leddy J.J., Smolinski R.J., Lawrence J., Synder J.L., Priore R.L. Prospective evaluation of the Ottawa ankle rules in a university sports medicine center, with a modification to increase specificity for identifying malleolar fractures. Am J Sports Med. 1998;26:158–165. doi: 10.1177/03635465980260020201. [DOI] [PubMed] [Google Scholar]
  • 17.Pigman E.C., Klug R.K., Sandford S., Jolly B.T. Evaluation of the Ottawa clinical decision rules for the use of radiography in acute ankle and mid-foot injuries in the emergency department: an independent site assessment. Ann Emerg Med. 1994;24:41–45. doi: 10.1016/s0196-0644(94)70160-1. [DOI] [PubMed] [Google Scholar]
  • 18.Markert R.J., Walley M.E., Guttman T.G., Mehta R. A pooled analysis of the Ottawa ankle rules used on adults in the emergency department. Am J Emerg Med. 1998;16:564–567. doi: 10.1016/s0735-6757(98)90219-4. [DOI] [PubMed] [Google Scholar]
  • 19.Lucchesi G.M., Jackson R.E., Peacock W.F., Cerasani C., Swor R.A. Sensitivity of the Ottawa rules. Ann Emerg Med. 1995;26:1–5. doi: 10.1016/s0196-0644(95)70229-6. [DOI] [PubMed] [Google Scholar]
  • 20.Verma S., Hamilton K., Hawkins H.H., Kothari R., Singal B., Buncher R. Clinical application of the Ottawa ankle rules for the use of radiography in acute ankle injuries: an independent site assessment. Am J Roentgenol. 1997;169:825–827. doi: 10.2214/ajr.169.3.9275906. [DOI] [PubMed] [Google Scholar]
  • 21.Aginaga J.R., Ventura I., Tejera E., Huarte I., Cuende A., Gómez M. Validación de las reglas del tobillo de Ottawa para el uso eficiente de radio-grafías en las lesiones agudas del tobillo. Aten Primaria. 1999;24:203–208. [PubMed] [Google Scholar]
  • 22.Perry S., Raby N., Grant P.T. Prospective survey to verify the Ottawa ankle rules. J Accid Emerg Med. 1999;16:258–260. doi: 10.1136/emj.16.4.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Tay S.Y., Thoo F.L., Sitoh Y.Y., Seow E., Wong H.P. The Ottawa ankle rules in Asia: validating a clinical decision rule for requesting X-rays in twisting ankle and foot injuries. J Emerg Med. 1999;17:945–947. doi: 10.1016/s0736-4679(99)00120-1. [DOI] [PubMed] [Google Scholar]
  • 24.Kelly A.M., Richards D., Kerr L., Grant J., O’Donovan I., Basire K. Failed validation of a clinical decision rule for the use of radiography in acute ankle injury. N Z Med J. 1994;107:294–295. [PubMed] [Google Scholar]
  • 25.Plint A.C., Bulloch B., Osmond M.H., Stiell I., Dunlap H., Reed M. Validation of the Ottawa ankle rules in children with ankle injuries. Acad Emerg Med. 1999;6:1005–1009. doi: 10.1111/j.1553-2712.1999.tb01183.x. [DOI] [PubMed] [Google Scholar]
  • 26.Libetta C., Burke D., Brennan P., Yassa J. Validation of the Ottawa ankle rules in children. J Accid Emerg Med. 1999;16:342–344. doi: 10.1136/emj.16.5.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Vidya T., Chande M.D. Decision rules for roentgenography of children with acute ankle injuries. Arch Pediatr Adolesc Med. 1995;149:255–258. doi: 10.1001/archpedi.1995.02170150035005. [DOI] [PubMed] [Google Scholar]
  • 28.Mann C.J., Grant I., Guly H., Hughes P. Use of the Ottawa ankle rules by nurse practitioners. J Accid Emerg Med. 1998;15:315–316. doi: 10.1136/emj.15.5.315. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Salt P., Clancy M. Implementation of the Ottawa ankle rules by nurses working in an accident and emergency department. J Accid Emerg Med. 1997;14:363–365. doi: 10.1136/emj.14.6.363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Allerston J., Justham D. Nurse practitioners and the Ottawa ankle rules: comparisons with medical staff in requesting X-rays for ankle injured patients. Accid Emerg Nurs. 2000;8:110–115. doi: 10.1054/aaen.2000.0103. [DOI] [PubMed] [Google Scholar]
  • 31.Graham I.D., Stiell I.G., Laupacis A., O’Connor A.M., Wells G.A. Emergency physicians’ attitudes toward and use of clinical decision rules for radiography. Acad Emerg Med. 1998;5:134–140. doi: 10.1111/j.1553-2712.1998.tb02598.x. [DOI] [PubMed] [Google Scholar]
  • 32.Auleley G.R., Ravaud P., Giraudeau B. Implementation of the Ottawa ankle rules in France. A multicenter randomized controlled trial. JAMA. 1997;277:1935–1939. [PubMed] [Google Scholar]
  • 33.Verbeek P.R., Stiell I.G., Hebert G., Sellens C. Ankle radiograph utilization after learning a decision rule: a 12-month follow-up. Acad Emerg Med. 1997;4:776–779. doi: 10.1111/j.1553-2712.1997.tb03783.x. [DOI] [PubMed] [Google Scholar]
  • 34.Cameron C., Naylor C.D. No impact from active dissemination of the Ottawa Ankle Rules: further evidence of the need for local implementation of practice guidelines. CMAJ. 1999;160:1165–1168. [PMC free article] [PubMed] [Google Scholar]
  • 35.Aginaga J.R., Fernández K., Pascual N., Oyarzábal I., Argaia J., Lizaso M.J. Análisis de la implementación de unas reglas de decisión clínica: reglas del tobillo de Ottawa. Emergencias. 2000;12:80–89. [Google Scholar]
  • 36.Anis A.H., Stiell I.G., Stewart D.G., Laupacis A. Cost-effectiveness analysis of the Ottawa ankle rules. Ann Emerg Med. 1995;26:422–428. doi: 10.1016/s0196-0644(95)70108-7. [DOI] [PubMed] [Google Scholar]

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES