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J Emerg Med. 2017 Sep;53(3):353-368. doi: 10.1016/j.jemermed.2017.04.035. Epub 2017 Jul 29.

Diagnostic Accuracy of Clinical Decision Rules to Exclude Fractures in Acute Ankle Injuries: Systematic Review and Meta-analysis.

Author information

1
Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, Eyssoniusplein, Groningen, the Netherlands; Physical Therapy Practice SKS, Thorbeckelaan, Assen, the Netherlands.
2
Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, Eyssoniusplein, Groningen, the Netherlands.
3
School of Health Studies, Physiotherapy, Hanze University of Applied Sciences, Eyssoniusplein, Groningen, the Netherlands.
4
Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, Eyssoniusplein, Groningen, the Netherlands; Department of Rehabilitation Medicine, University Medical Center, University of Groningen, Groningen, the Netherlands.
5
Physical Therapy Practice Noorderbad, Oosterhamrikkade, Groningen, the Netherlands.

Abstract

BACKGROUND:

Ankle decision rules are developed to expedite patient care and reduce the number of radiographs of the ankle and foot. Currently, only three systematic reviews have been conducted on the accuracy of the Ottawa Ankle and Foot Rules (OAFR) in adults and children. However, no systematic review has been performed to determine the most accurate ankle decision rule.

OBJECTIVES:

The purpose of this study is to examine which clinical decision rules are the most accurate for excluding ankle fracture after acute ankle trauma.

METHODS:

A systematic search was conducted in the databases PubMed, CINAHL, PEDro, ScienceDirect, and EMBASE. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of the included studies were calculated. A meta-analysis was conducted if the accuracy of a decision rule was available from at least three different experimental studies.

RESULTS:

Eighteen studies satisfied the inclusion criteria. These included six ankle decision rules, specifically, the Ottawa Ankle Rules, Tuning Fork Test, Low Risk Ankle Rule, Malleolar and Midfoot Zone Algorithms, and the Bernese Ankle Rules. Meta-analysis of the Ottawa Ankle Rules (OAR), OAFR, Bernese Ankle Rules, and the Malleolar Zone Algorithm resulted in a negative likelihood ratio of 0.12, 0.14, 0.39, and 0.23, respectively.

CONCLUSION:

The OAR and OAFR are the most accurate decision rules for excluding fractures in the event of an acute ankle injury.

KEYWORDS:

ankle; decision rules; diagnostic accuracy studies; fracture; sensitivity; specificity

PMID:
28764972
DOI:
10.1016/j.jemermed.2017.04.035
[Indexed for MEDLINE]

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