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Likelihood Ratio (LR) in Emergency Medicine

4/11/2014

Ottawa ankle rules. 
Does it really work?

Clinical Scenario

A 16 yo guy is brought in ED by his mother after a scholar accident.
While he was running, he crashed. 
My son has a sore ankle!  Is it broken? Asks the mother seriously worried.  
The ankle his slightly tumefied, there isn’t bone tenderness at the posterior edge or tips of either malleolus, neither there is pain during the pressure of the navicular bone or the base of the fifth metatarsal. 
Are you able to take 4 steps? - asks the doctor.







Conclusion 

If correctly performed (see the video) the Ottawa ankle rules have been shown to have high sensitivity, so if there is not an high pretest probability it rules out a fracture without any further test.
Their use leads to reduction of radiography, costs, and waiting time. 


Bibliography 

LM Bachmann
Systematic review.
BMJ vol 326 22 feb 2003

IG Stiell 
JAMA 1993 3 March vol 269 n9


Ciro Paolillo e Ilenia Spallino

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    KU School of medicine

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