A Prospective Study Comparing Different Clinical Decision Rules in Adult and Pediatric Ankle Trauma

A Prospective Study Comparing Different Clinical Decision Rules in Adult and Pediatric Ankle Trauma

Comparison of the reliability of different examination techniques to detect fractures in patients with ankle trauma.

Patients with ankle trauma frequently present in the emergency department. In many institutions radiographies of the ankle and foot are obtained in most of these patients, although significant fractures occur only in 15%. Therefore clinical decision rules were developed to clinically rule out significant ankle fractures, thereby reducing the number of radiographies resulting in significant time and cost savings.

Up until now the Ottawa Ankle and Foot Rules are the only clinical decision rules for ankle trauma that are widely accepted. They have a high sensitivity for the detection of fractures but a relatively low specificity. This led to the development of alternative clinical decision rules claiming equally high sensitivity but improved specificity. These alternatives have mostly not been replicated nor have they been directly compared.

This is what the researchers want to do in this study: compare different clinical decision rules regarding sensitivity and specificity. Radiographies of ankle and foot made for every patient are used as the gold standard for the detection of fractures.

Different clinical decision rules will be compared in a pediatric (5-15 years) and an adult population (from 16 years onwards). The researchers consider a clinical decision rule acceptable of it has a sensitivity of at least 95% and a specificity of at least 25%.

Inclusion Criteria:

• Pain due to blunt trauma to the ankle
• Must be at least 5 years old

Exclusion Criteria:

• Skin defects in the injured area
• Time of trauma > 72 hours before presentation
• Multiple significant injuries making clinical examination impossible
• Clinically obvious fracture
• Re-evaluation
• Referred with radiography
• Result of radiography already known to investigator
• Glasgow Coma Scale < 15