Doğan Burcu, Komut Seval, Komut Erdal, Kavak Nezih, Güneş Osmancan, Karahan Anılcan Tahsin
Department of Emergency, Faculty of Medicine, University of Health Sciences, Ankara, Turkiye.
Department of Emergency, Faculty of Medicine, Hitit University, Çorum, Turkiye.
Turk J Med Sci. 2025 Jun 14;55(4):887-892. doi: 10.55730/1300-0144.6041. eCollection 2025.
BACKGROUND/AIM: Foot and ankle trauma represents a common reason for emergency department visits. While the majority of cases involve soft tissue injuries, radiographic imaging is frequently overutilized due to concerns about missed fractures, leading to increased costs and emergency department crowding. The Shetty test, a recently introduced clinical decision rule, may serve as a simpler alternative to established tools such as the Ottawa ankle rules. This study aimed to assess the diagnostic accuracy of the Shetty test and its potential role as a supportive tool within existing triage systems for patients presenting with foot and ankle trauma.
In this cross-sectional study, 229 adult patients with isolated foot or ankle trauma were evaluated in the emergency department. All participants underwent the Shetty test and standard radiographic imaging. The Shetty test was performed by trained emergency physicians prior to imaging; a positive result was defined as an inability to apply downward pressure due to pain. Diagnostic accuracy metrics-including sensitivity, specificity, positive predictive value, and negative predictive value-were calculated using radiographic findings as the reference standard.
Fractures were identified in 25.3% of cases. The Shetty test demonstrated a sensitivity of 77.6%, specificity of 60.8%, positive predictive value of 40.2%, and a high negative predictive value of 88.9%. Among patients with confirmed fractures, 77.6% had a positive test result. The test performed best in ruling out displaced and incomplete fractures, and results showed significant correlation with both physical findings and imaging outcomes.
The Shetty test exhibited moderate sensitivity and specificity, alongside a high negative predictive value, supporting its use as a reliable rule-out tool for foot and ankle fractures. Its simplicity, ease of application, and diagnostic potential make it a promising triage adjunct to optimize emergency department resource use. Prospective multicenter validation is warranted before broad clinical adoption.
背景/目的：足踝创伤是急诊就诊的常见原因。虽然大多数病例涉及软组织损伤，但由于担心漏诊骨折，X线成像经常被过度使用，导致成本增加和急诊科拥挤。Shetty试验是最近引入的一种临床决策规则，可能是渥太华踝关节规则等现有工具的更简单替代方法。本研究旨在评估Shetty试验的诊断准确性及其作为现有分诊系统中足踝创伤患者辅助支持工具的潜在作用。
在这项横断面研究中，对急诊科229例孤立性足或踝创伤的成年患者进行了评估。所有参与者均接受了Shetty试验和标准X线成像。Shetty试验由训练有素的急诊医师在成像前进行；阳性结果定义为因疼痛无法施加向下压力。以X线检查结果作为参考标准，计算诊断准确性指标，包括敏感性、特异性、阳性预测值和阴性预测值。
25.3%的病例发现骨折。Shetty试验的敏感性为77.6%，特异性为60.8%，阳性预测值为40.2%，阴性预测值高达88.9%。在确诊骨折的患者中，77.6%的试验结果为阳性。该试验在排除移位和不完全骨折方面表现最佳，结果与体格检查结果和影像学结果均显著相关。
Shetty试验表现出中等的敏感性和特异性，以及较高的阴性预测值，支持将其用作足踝骨折的可靠排除工具。其简单性、易于应用和诊断潜力使其成为优化急诊科资源使用的有前景的分诊辅助手段。在广泛临床应用之前，有必要进行前瞻性多中心验证。
