Department of Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.
CJEM. 2011 Sep;13(5):333-8; E44-6.
A number of studies have assessed the diagnostic accuracy of the Ottawa Ankle Rules (OAR) in children; however, the role of the OAR in guiding physician radiograph use is unclear.
The primary purpose of this study was to determine the extent to which Canadian pediatric emergency physicians report using the OAR. Secondary goals included determining current diagnostic and management strategies for Salter-Harris 1 (SH-1) injuries of the ankle and which fractures physicians deem to be clinically significant.
A self-administered piloted survey was distributed by mail to 215 Canadian pediatric emergency physicians using a modified Dillman technique. Participants were selected through Pediatric Emergency Research Canada (PERC), a national network of health care professionals with an interest in pediatric emergency medicine research.
Of 209 surveys, 144 were returned, for a response rate of 68.9%. Of those, 87.5% (126 of 144) reported applying the OAR in children to determine the need for radiographs in acute ankle or midfoot injuries. Of those, 65.1% reported using the OAR always or usually, and 64.5% (93 of 144) of physicians stated that they believe all ankle fractures are clinically significant. Although physicians report that they most commonly order the radiographs, 36.2% of participants indicated that radiographs were requisitioned by nurses or other health care providers at their facilities. SH-1 fractures were reported to be most commonly managed by immobilization (83.3%; 120 of 144), with most patients going on to follow-up with an orthopedic surgeon.
The majority of Canadian pediatric emergency physicians indicate that they use the OAR when assessing children with acute ankle and midfoot injuries. Most physicians believe that all ankle fractures, including SH-1, are clinically significant and have a management preference for immobilization and orthopedic follow-up.
多项研究评估了渥太华踝关节规则（OAR）在儿童中的诊断准确性；然而，OAR 指导医生进行 X 光检查的作用尚不清楚。
本研究的主要目的是确定加拿大儿科急诊医生报告使用 OAR 的程度。次要目标包括确定目前踝关节 Salter-Harris 1（SH-1）损伤的诊断和管理策略，以及医生认为哪些骨折具有临床意义。
使用经过修改的 Dillman 技术，通过加拿大儿科急诊研究（PERC）向 215 名加拿大儿科急诊医生邮寄了一份自我管理的试点调查。参与者是通过对儿科急诊医学研究有兴趣的医疗保健专业人员的全国网络 PERC 选择的。
在 209 份调查中，有 144 份被退回，回复率为 68.9%。其中，87.5%（126/144）报告在儿童急性踝关节或中足部损伤中应用 OAR 确定是否需要 X 光检查。其中，65.1%的医生报告经常或通常使用 OAR，64.5%（144 名医生中的 93 名）的医生表示他们认为所有踝关节骨折都具有临床意义。尽管医生报告说他们最常开具 X 光检查，但 36.2%的参与者表示他们所在机构的护士或其他医疗保健提供者会开 X 光检查单。报告称，SH-1 骨折最常通过固定（83.3%；144 名医生中的 120 名）进行治疗，大多数患者继续由骨科医生进行随访。
大多数加拿大儿科急诊医生表示，他们在评估儿童急性踝关节和中足部损伤时使用 OAR。大多数医生认为所有踝关节骨折，包括 SH-1，都具有临床意义，他们更喜欢固定和骨科随访的治疗方法。
