Medical Student, Georgetown University School of Medicine, Washington, DC.
Resident Physician, Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
J Foot Ankle Surg. 2020 Mar-Apr;59(2):286-290. doi: 10.1053/j.jfas.2019.04.017.
The Ottawa ankle rules (OAR) indicate that any patient with the inability to ambulate up to four steps or with tenderness at either malleoli should receive diagnostic imaging for an acute ankle injury. Current trends indicate that health care providers tend to order more images in practice than necessary according to OAR. The purpose of this study is to analyze OAR in geriatric versus nongeriatric patients. Secondarily, we hope to refine these guidelines for ankle imaging in the hopes that health care providers will be comfortable in adhering to these guidelines more strictly. A retrospective chart review was conducted of 491 adult patients with an average (± standard deviation) age of 54.4 ± 21.6 years (range 18 to 96). Applying the current OAR resulted in a sensitivity of 98.2% and a specificity of 58.6% in this entire cohort. The calculated sensitivities were comparable between the nongeriatric and geriatric cohorts, at 98.60% and 97.99%, respectively. The specificities varied between the nongeriatric and geriatric cohorts, at 60.13% and 33.33%. We propose new guidelines that would mandate imaging studies for any patient ≥65 years of age presenting to the emergency department with ankle pain. When applying these proposed guidelines, the sensitivity of the entire study population was found to be improved to 99.0%, whereas the specificity dropped to 56.7%. The slight decrease in specificity was deemed acceptable because these guidelines are meant to be used as a screening tool and because the risk of OAR not correctly identifying ankle fracture (2% of geriatric fractures) was completely mitigated in the geriatric population.
渥太华踝关节规则（OAR）指出，任何无法行走四步或内外踝有压痛的患者都应接受急性踝关节损伤的影像学诊断。目前的趋势表明，医疗保健提供者在实践中往往会根据 OAR 比必要的情况下更多地订购图像。本研究的目的是分析 OAR 在老年患者与非老年患者中的应用。其次，我们希望改进这些踝关节成像指南，希望医疗保健提供者能够更严格地遵守这些指南。对 491 名平均（±标准差）年龄为 54.4±21.6 岁（范围 18 至 96 岁）的成年患者进行了回顾性图表审查。在整个队列中，当前的 OAR 应用的敏感性为 98.2%，特异性为 58.6%。在非老年组和老年组中，计算出的敏感性分别为 98.60%和 97.99%，相当。在非老年组和老年组中，特异性分别为 60.13%和 33.33%，存在差异。我们提出了新的指南，规定任何年龄≥65 岁的因踝关节疼痛就诊急诊科的患者都需要进行影像学检查。应用这些建议的指南时，整个研究人群的敏感性提高到 99.0%，而特异性下降到 56.7%。特异性略有下降被认为是可以接受的，因为这些指南旨在用作筛查工具，并且 OAR 未能正确识别踝关节骨折（老年骨折的 2%）的风险在老年人群中已完全消除。
