Clark Kathryn D, Tanner Suzanne
University of Colorado Health Sciences Center, The Children's Hospital, Denver, Colorado, USA.
Pediatr Emerg Care. 2003 Apr;19(2):73-8. doi: 10.1097/00006565-200304000-00003.
The Ottawa Ankle Rules (OAR) are criteria for predicting ankle fractures in adults allowing for insignificant fractures, defined as small avulsion fractures. Because the clinical significance of avulsion fractures and Salter-Harris type I fractures in children is unclear, we sought to prospectively evaluate the use of the OAR in children and to determine whether different criteria should be used for predicting ankle fractures in children.
In this prospective study, patients younger than 18 years presenting to a pediatric emergency department (ED) with an acute nonpenetrating ankle injury were eligible for study participation. Information on 22 clinical variables was recorded on a standardized data sheet. The OAR were included but not specifically identified on the data sheets. A standard ankle radiographic series was obtained on all subjects. All fractures were considered to be significant. Follow-up phone calls were performed to assess final diagnosis and outcome. Sensitivity and specificity of OAR and other potential criteria for predicting ankle fractures in children were calculated.
A total of 195 patients with ankle injuries were evaluated. The mean age of patients was 12.6 years. Forty fractures (21%) were identified. The sensitivity of OAR was 83% (95% CI, 65-94%), specificity was 50% (95% CI, 41-59%), positive predictive value was 28%, and negative predictive value was 93%. Three independent factors were significantly associated with ankle fractures: inability to walk immediately after the event, inability to bear weight for four steps in the ED, and tender deltoid ligament. If one or more of these factors were present, sensitivity for predicting ankle fractures was 93% (95% CI, 78-99%), specificity was 27% (95% CI, 20-36%), positive predictive value was 23%, and negative predictive value was 95%.
The OAR cannot be applied to children with the same sensitivity as adults.
渥太华踝关节规则（OAR）是用于预测成人踝关节骨折的标准，其中允许存在无明显临床意义的骨折，即小的撕脱性骨折。由于儿童撕脱性骨折和Salter-Harris I型骨折的临床意义尚不清楚，我们旨在前瞻性评估OAR在儿童中的应用，并确定是否应使用不同标准来预测儿童踝关节骨折。
在这项前瞻性研究中，年龄小于18岁、因急性非穿透性踝关节损伤就诊于儿科急诊科（ED）的患者符合研究参与条件。在标准化数据表上记录了22项临床变量的信息。OAR被纳入但未在数据表上明确标识。对所有受试者进行了标准的踝关节X线检查系列。所有骨折均被视为有明显临床意义。通过随访电话评估最终诊断和结果。计算了OAR及其他预测儿童踝关节骨折的潜在标准的敏感性和特异性。
共评估了195例踝关节损伤患者。患者的平均年龄为12.6岁。共识别出40例骨折（21%）。OAR的敏感性为83%（95%CI，65 - 94%），特异性为50%（95%CI，41 - 59%），阳性预测值为28%，阴性预测值为93%。三个独立因素与踝关节骨折显著相关：伤后立即无法行走、在急诊科无法负重行走4步以及三角韧带压痛。如果存在一个或多个这些因素，预测踝关节骨折的敏感性为93%（95%CI，78 - 99%），特异性为27%（95%CI，20 - 36%），阳性预测值为23%，阴性预测值为95%。
OAR应用于儿童时，其敏感性与成人不同。
