Ottawa Ankle Rules
Il trauma distorsivo di caviglia e del piede è tra le cause di accesso più frequenti al Pronto Soccorso, nonostante ciò, la frequenza di fratture della tibio-tarsica risulta essere del 15%. Nella pratica clinica la quasi totalità dei pazienti viene sottoposta a valutazione radiografica con una percentuale di radiografie negative per frattura stimata intorno all’85% degli esami.
Basandosi su tali presupposti, Steill et al. hanno sviluppato e validato nel 1992 uno strumento diagnostico, denominato Ottawa Ankle Rules (OARs), in grado di escludere con una sensibilità prossima al 100% la diagnosi di frattura pur in assenza di documentazione radiografica aumentando con ciò, in ultima analisi, l’appropriatezza delle richieste radiografiche per le patologie traumatiche minori del piede e del mesopiede. L’utilizzo di “decision rules” nella pratica clinica permette infatti di ridurre il numero di radiografie eseguite nella misura stimata dagli Autori del 26,4% senza alcun detrimento qualitativo della prestazione medica e senza un apprezzabile incremento di omissioni diagnostiche di eventi fratturativi.

Ottawa ankle rules

Ottawa Ankle Rules

 

Bibliografia

Riferimenti

  1. Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and midfoot in children: A meta-analysis. Acad Emerg Med 2009;16(4):277-287
  2. PMID 12595378
  3. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992 Apr;21(4):384-90. PMID 1554175.
  4. Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa ankle rules. JAMA. 1994 Mar 16;271(11):827-32. PMID 8114236.
  5. Stiell I, Wells G, Laupacis A, Brison R, Verbeek R, Vandemheen K, Naylor CD. Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group. BMJ. 1995 Sep 2;311(7005):594-7. PMID 7663253Full Text.
  6. Blackham JEJ, Claridge T, Benger JR (2008). “Can patients apply the Ottawa ankle rules to themselves?”. Emergency Medicine J25 (11): 750–751. doi:10.1136/emj.2008.057877PMID 18955612.
  7. Stiell IG, Greenberg GH, Wells GA, McDowell I, Cwinn AA, Smith NA, Cacciotti TF, Sivilotti MLA. “Prospective validation of a decision rule for use of radiography in acute knee injury”. Journal of the American Medical Association (1996) 275:611-615
  8. http://www.ohri.ca/emerg/cdr/knee.html

Collegamenti esterni

4 commenti

  • Samuele Passigli Reply

    Tayeb R. Diagnostic value of Ottawa ankle rules: simple guidelines with high sensitivity. Br J Sports Med. 2013 Jul;47(10):e3. doi: 10.1136/bjsports-2013-092558.71. PubMed PMID: 23757699.
    Abstract
    PURPOSE:
    Ankle and foot injuries are one of the most common acute sport injuries. The objective was to conduct a study to determine the accuracy of the Ottawa Ankle Rules (OARs) to rule out ankle and midfoot fractures in athletes’ population presenting with blunt ankle and midfoot injuries.
    METHODS:
    Two physicians assessed the OARs in 1156 athletes and 1329 radiographs. Radiography was performed in each patient after clinical evaluation. Findings were recorded. An expert radiologist who was blinded to clinical exanimation interpreted the radiographs.
    FINDINGS:
    Of the 1329 radiographs from ankle and midfoot trauma, 93 ankle and 71 midfoot fractures were diagnosed. All cases with a fracture had a positive OARs result (sensitivity 100% 95% CI; 97-100) and of 1165 radiographs without a fracture, the OARs were negative in 439 cases (specificity 37%; 34-40).The corresponding potential savings in radiographs was 33% using the OAR. The interobserver agreement for our two independent assessors was substantial. (?=0.79, SE=0.11).
    CONCLUSION:
    This validation study of the OARs in an Iranian athletes’ population produced similar results than those published previously in various other settings. We confirmed the previous studies that the OARs could be a reliable tool to exclude fractures and could aid sport medicine physicians make proper decisions on field and in clinic about athletes who suffered from ankle and midfoot trauma. Employing OARs would significantly decrease radiography requests and costs.

  • Samuele Passigli Reply

    Wang X, Chang S-m, Yu G-r, Rao Z-t (2013) Clinical Value of the Ottawa Ankle Rules for Diagnosis of Fractures in Acute Ankle Injuries. PLoS ONE 8(4): e63228. doi:10.1371/journal.pone.0063228

  • Samuele Passigli Reply

    Interessante questa review:
    Lin CW, Uegaki K, Coupé VM, Kerkhoffs GM, van Tulder MW. Economic evaluations
    of diagnostic tests, treatment and prevention for lateral ankle sprains: a
    systematic review. Br J Sports Med. 2012 May 3.

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