Pijnenburg A C M, Glas Afina S, De Roos Marnix A J, Bogaard Kjell, Lijmer Jeroen G, Bossuyt Patrick M M, Butzelaar Rudolf M J M, Keeman Johannes N
Department of Surgery, Sint Lucas Andreas Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Ann Emerg Med. 2002 Jun;39(6):599-604. doi: 10.1067/mem.2002.121397.
We validate the Ottawa Ankle Rules and 2 Dutch ankle rules in distinguishing clinically significant fractures from insignificant fractures and other injuries in patients with a painful ankle presenting to the emergency department.
This prospective comparison of 3 ankle rules was conducted in the ED of a 580-bed community teaching hospital in Amsterdam from January 1998 to April 1999. Participants included 647 consecutive patients aged 18 years or older presenting with a painful ankle after trauma. All physicians received extensive and pictorial training on how to correctly score the respective items of the rules. The physician on call recorded these items derived from history and physical examination on a standardized data sheet. All patients subsequently underwent standard radiographic assessment. A radiologist and a trauma surgeon evaluated the radiographs blinded from the results of the data sheet form and the treatment given. The diagnostic performance of the 3 rules was measured in terms of sensitivity, specificity, and the reduction of radiographs. Receiver operating characteristic (ROC) curves were constructed, and the area under the ROC curves was calculated and compared.
Seventy-four fractures were seen, of which 41 were clinically significant. The Ottawa Ankle Rules had a sensitivity of 98% for identifying clinically significant fractures; the local rules scored 88% and 59%, respectively. The potential savings in radiographs for the 3 decision rules were 24%, 54%, and 82%, respectively. The area under the ROC curve was better for both the local rules (0.84 and 0.83) compared with the Ottawa Ankle Rules (0.76).
Because the identification of all relevant fractures is more important than a reduction in radiographs, the higher sensitivity of the Ottawa Ankle Rules makes these most suitable for implementation in The Netherlands.
我们验证渥太华踝关节规则和两条荷兰踝关节规则，以区分急诊科就诊的踝关节疼痛患者中具有临床意义的骨折与无意义的骨折及其他损伤。
1998年1月至1999年4月，在阿姆斯特丹一家拥有580张床位的社区教学医院的急诊科对三条踝关节规则进行了前瞻性比较。参与者包括647例18岁及以上因创伤后踝关节疼痛而连续就诊的患者。所有医生都接受了关于如何正确对规则的各个项目进行评分的广泛且配有图片的培训。值班医生在标准化数据表上记录从病史和体格检查中得出的这些项目。随后所有患者均接受标准的影像学评估。一名放射科医生和一名创伤外科医生在不知道数据表结果和所给予治疗的情况下评估X光片。根据敏感性、特异性和X光片减少情况来衡量这三条规则的诊断性能。构建了受试者工作特征（ROC）曲线，并计算和比较了ROC曲线下的面积。
共发现74处骨折，其中41处具有临床意义。渥太华踝关节规则识别具有临床意义骨折的敏感性为98%；两条荷兰本地规则的敏感性分别为88%和59%。这三条决策规则在X光片检查方面潜在的节省比例分别为24%、54%和82%。与渥太华踝关节规则（0.76）相比，两条荷兰本地规则的ROC曲线下面积更好（分别为0.84和0.83）。
由于识别所有相关骨折比减少X光片检查更为重要，渥太华踝关节规则的较高敏感性使其最适合在荷兰实施。
