McBride K L
Dartmouth Medical Centre, NS.
Can Fam Physician. 1997 Mar;43:459-65.
To test the validity of a set of defined and tested rules for decisions on use of radiography for acute ankle injuries.
Prospective survey.
Community hospital emergency department managing 42000 visits annually.
A non-consecutive sample of 318 adults and children presenting during 1 year was evaluated by 25 family physicians in part-time emergency practice.
Participating physicians interpreted the Ottawa ankle rules for all enrolled patients and ordered radiographs in 96% of cases.
Sensitivity of the Ottawa ankle rules to predict whether radiography is required for acute ankle injuries.
Of the 318 cases, 22 incomplete records were excluded, leaving 259 records of adults and 37 records of patients younger than 16 accepted for analysis. Of 34 adult patients with identified fractures, only one was predicted by the rules not to require radiographs. Sensitivity of the rules was 0.971 (confidence interval [CI] 0.914 to 1.00), specificity was 0.302 (CI 0.242 to 0.362), positive predictive value was 0.174 (CI 0.120 to 0.228), and negative predictive value was 0.986 (CI 0.971 to 1.00). Radiography could have been reduced by 26.3% had the rules been applied. Of the 37 children, seven had fractures. All were properly identified by the rules. Radiography in this group could have been reduced by 22%.
This study validates the Ottawa ankle rules and supports their use. Further research on how the rules apply to children is required.
检验一套用于急性踝关节损伤时决定是否进行X线检查的既定且经过测试的规则的有效性。
前瞻性调查。
每年接诊42000人次的社区医院急诊科。
由25名从事兼职急诊工作的家庭医生对1年内就诊的318名成人及儿童的非连续样本进行评估。
参与研究的医生对所有入组患者解读渥太华踝关节规则，并在96%的病例中开具了X线检查。
渥太华踝关节规则预测急性踝关节损伤是否需要进行X线检查的敏感性。
318例病例中，排除22份不完整记录，剩余259份成人记录和37份16岁以下患者记录纳入分析。在34例确诊骨折的成年患者中，规则预测只有1例无需进行X线检查。该规则的敏感性为0.971（置信区间[CI] 0.914至1.00），特异性为0.302（CI 0.242至0.362），阳性预测值为0.174（CI 0.120至0.228），阴性预测值为0.986（CI 0.971至1.00）。若应用该规则，X线检查可减少26.3%。37例儿童中，7例有骨折。所有骨折均被规则正确识别。该组的X线检查可减少22%。
本研究验证了渥太华踝关节规则并支持其应用。需要进一步研究该规则如何适用于儿童。
