Ravaud P, Auleley GR, Kerboull L, Durieux P; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1996; 12: 31.
Delegation a l'Evaluation Medicale, DPIM, Assistance Publique-Hopitaux de Paris, France.
OBJECTIVE: Decision rules for the use of radiography in acute ankle and midfoot injuries (Ottawa Ankle Rules) have been developed by Stiell and coworkers (Stiell et al., Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. BMJ, 1995, 311:594-597). This study assessed the efficacy of these rules with less experienced health care providers and who had not been involved in their development. METHODS: This prospective patient survey was performed in the Emergency Department (ED) of a French teaching hospital. The ED of this 1,100 acute bed hospital treats approximately 30,000 patients annually. Four hundred sixteen patients older than 18 years referred for acute ankle or midfoot injuries during four months were studied. The physicians evaluated each patient for clinical variables and recorded their findings on a data collection sheet. All the patients were then referred for radiographs which were interpreted by a radiologist blinded to clinical data. RESULTS: Patients were seen by a surgery residents (56%), a resident in family medicine (36%) or a part-time general practitioner (8%). Seventy eight fractures and avulsions were diagnosed. The rules were found to have sensitivities of 0.98 (95% CI, 0.89 to 1.0), for detecting malleolar zone fractures, and 1.0 (95% CI, 0.85 to 1.0) for midfoot zone fractures. The probability of a fracture if the corresponding decision rule was negative was estimated to be 0.8% in the ankle series and 0% in the foot series. Application of the Ottawa rules by ED physicians would have resulted in 31% reduction in use of midfoot and ankle radiographs. CONCLUSION: The results confirm that OAR are applicable with sensitivity approaching 100% by users external to their development, less experienced than Canadian ED physicians, and in a different health care system. We are conducting a multicenter randomized study for assessing the implementation of OAR in Paris Hospitals.
Publication Types:
Keywords:
- Animals
- Ankle Injuries
- Canada
- Data Collection
- Foot
- Foot Injuries
- Fractures, Bone
- France
- Hospitals, Teaching
- Humans
- Longitudinal Studies
- Paris
- Sensitivity and Specificity
- Tarsal Bones
- Tarsus, Animal
- radiography
- utilization
- hsrmtgs
Other ID:
UI: 102222562
From Meeting Abstracts