[Validation of the Ottawa ankle rules for the efficient utilization of radiographies in acute lesions of the ankle]. / Validación de las reglas del tobillo de Ottawa para el uso eficiente de radiografías en las lesiones agudas de tobillo.

ABSTRACT

OBJECTIVE: To test the validity of Ottawa ankle rules (OAR) in our field. To test the agreement physician/nurse in the assessment of the patient with acute ankle injuries. DESIGN: Observational, with application of rules and prospective outcome measurement. SETTING: Hospital emergency departments. PARTICIPANTS: Adults who attended at the emergency department, suffering from a secondary ankle pain to a traumatic injury, from 1st March to 30th September, 1997. MEASUREMENTS AND MAIN RESULTS: Physicians who participated applied the OAR to the patients and asked for a control radiograph, independently from the result of rules application. 100 patients were valued by a physician and a nurse in order to measure the agreement level. Data from 564 patients were recorded, getting a global sensitivity of the OAR of 97.3% (95% CI 89.7-99.5); specificity of 33.3% (95% CI 29.5-37.3). The positive predictive value was of 15.6 (95% CI 12.4-19.3). Thanks to the application of the rules radiography would reduce by 29.5%. 74 (13.1%) patients suffered form fracture 48 (8.5%), of the maleolar zone and 26 (4.6%) of the midfoot zone. Attending to the OAR criteria, radiographs wouldn't be necessary in two cases of fracture. CONCLUSIONS: We consider the OAR clinically valuable and useful in our field. They can help to work on the basis of uniform criteria when decisions must be taken and to use properly sanitary resources. Triage nurses can apply them.