Format

Send to

Choose Destination
See comment in PubMed Commons below
BMJ. 2003 Feb 22;326(7386):417.

Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review.

Author information

  • 1Horten Centre, Zurich University, Postfach Nord, CH-8091 Zurich, Switzerland. lucas.bachmann@evimed.ch

Abstract

OBJECTIVE:

To summarise the evidence on accuracy of the Ottawa ankle rules, a decision aid for excluding fractures of the ankle and mid-foot.

DESIGN:

Systematic review.

DATA SOURCES:

Electronic databases, reference lists of included studies, and experts.

REVIEW METHODS:

Data were extracted on the study population, the type of Ottawa ankle rules used, and methods. Sensitivities, but not specificities, were pooled using the bootstrap after inspection of the receiver operating characteristics plot. Negative likelihood ratios were pooled for several subgroups, correcting for four main methodological threats to validity.

RESULTS:

32 studies met the inclusion criteria and 27 studies reporting on 15 581 patients were used for meta-analysis. The pooled negative likelihood ratios for the ankle and mid-foot were 0.08 (95% confidence interval 0.03 to 0.18) and 0.08 (0.03 to 0.20), respectively. The pooled negative likelihood ratio for both regions in children was 0.07 (0.03 to 0.18). Applying these ratios to a 15% prevalence of fracture gave a less than 1.4% probability of actual fracture in these subgroups.

CONCLUSIONS:

Evidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40%.

PMID:
12595378
PMCID:
PMC149439
DOI:
10.1136/bmj.326.7386.417
[PubMed - indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central Icon for PubMed Health
    Loading ...
    Support Center