Chande V T
Case Western Reserve University School of Medicine, Cleveland, Ohio.
Arch Pediatr Adolesc Med. 1995 Mar;149(3):255-8. doi: 10.1001/archpedi.1995.02170150035005.
The Ottawa Ankle Rules (OAR) assist emergency physicians in the appropriate use of roentgenography in adults with acute ankle injuries. The OAR state that ankle roentgenograms are needed only if there is pain near the malleoli and one or more of the following exists: (1) age 55 years or older; (2) inability to bear weight; or (3) bone tenderness at the posterior edge or tip of either malleolus. This study assessed the utility of the OAR on pediatric patients with acute ankle injuries.
Prospective, consecutive survey of pediatric patients with acute ankle injuries.
Pediatric emergency department of an urban university hospital.
Seventy-one children with acute ankle injuries were enrolled from July 22, 1993, to December 1, 1993.
Twenty-four standardized clinical variables were assessed and recorded by physicians in the pediatric emergency department. The OAR were applied to each patient by the investigator to determine which ones would qualify for roentgenography.
Sensitivity and specificity of the OAR were calculated, as was percent reduction in roentgenograms ordered.
Seventy-one of 73 eligible patients were enrolled. The two missed patients had open fractures of the tibia. Sixty-eight of 71 patients had ankle roentgenography during the visit. Fourteen patients (21%) (mean age, 11.8 +/- 4.0 years) had fractures noted on the roentgenograms. Fifty-four patients (79%) (mean age, 12.0 +/- 3.6 years) had no fracture. Application of the OAR would have reduced the number of roentgenograms ordered by 25% without missing any fractures. Sensitivity of OAR was 100% (95% confidence interval, 77% to 100%), specificity was 32% (95% confidence interval, 21% to 43%), negative predictive value was 100% (95% confidence interval, 80% to 100%), and positive predictive value was 28% (95% confidence interval, 17% to 39%).
Initial testing suggests that the OAR may help determine which children with acute ankle injuries could safely forgo roentgenograms without risk of missing fractures.
渥太华踝关节规则（OAR）有助于急诊医生对急性踝关节损伤的成人患者合理使用X线检查。OAR规定，仅当踝关节附近疼痛且存在以下一种或多种情况时才需要进行踝关节X线检查：（1）年龄55岁及以上；（2）无法负重；或（3）任何一侧内踝或外踝的后缘或尖端有骨压痛。本研究评估了OAR在急性踝关节损伤儿童患者中的实用性。
对急性踝关节损伤儿童患者进行前瞻性、连续性调查。
城市大学医院的儿科急诊科。
1993年7月22日至1993年12月1日，纳入71例急性踝关节损伤儿童。
儿科急诊科医生评估并记录24项标准化临床变量。研究者将OAR应用于每位患者，以确定哪些患者符合X线检查条件。
计算OAR的敏感性和特异性，以及X线检查申请减少的百分比。
73例符合条件的患者中有71例被纳入。2例未纳入的患者为胫骨开放性骨折。71例患者中有68例在就诊时进行了踝关节X线检查。14例患者（21%）（平均年龄11.8±4.0岁）X线检查显示有骨折。54例患者（79%）（平均年龄12.0±3.6岁）没有骨折。应用OAR可使X线检查申请数量减少25%，且不会遗漏任何骨折。OAR的敏感性为100%（95%置信区间，77%至100%），特异性为32%（95%置信区间，21%至43%），阴性预测值为100%（95%置信区间，80%至100%），阳性预测值为28%（95%置信区间，17%至39%）。
初步测试表明，OAR可能有助于确定哪些急性踝关节损伤儿童可以安全地不进行X线检查而不会有遗漏骨折的风险。
