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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%.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Adults | Experimental | Patients from 16 years of age onwards |
|
| Children | Experimental | Patients aged 5 to 15 years |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ottawa Ankle and Foot Rules | Procedure | As previously published |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Sensitivity for detection of significant fractures |
| At the first visit to the emergency department |
| Specificity for detection of significant fractures |
| At the first visit to the emergency department |
| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of proximal fibula fractures in ankle trauma | The prevalence of proximal fibula fractures in ankle trauma has, to the best of our knowledge, not yet been quantified. | At the first visit to the emergency department |
| Prevalence of gastrocnemius tendon rupture in ankle trauma |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dimitri Vandoninck, MD | Contact | +32 479 744 845 | dimitri_vandoninck@yahoo.com | |
| Marc Sabbe, MD, PhD | Contact | +32 16 343927 | marc.sabbe@uzleuven.be |
| Name | Affiliation | Role |
|---|---|---|
| Dimitri Vandoninck, MD | Emergency Department of the University Hospitals, Catholic University Leuven | Principal Investigator |
| Marc Sabbe, MD, PhD | Emergency Department of the University Hospitals, Catholic University Leuven |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Emergency Department of the University Hospitals, Catholic University Leuven | Leuven | Vlaams-Brabant | 3000 | Belgium |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 16385314 | Background | Eggli S, Sclabas GM, Eggli S, Zimmermann H, Exadaktylos AK. The Bernese ankle rules: a fast, reliable test after low-energy, supination-type malleolar and midfoot trauma. J Trauma. 2005 Nov;59(5):1268-71. doi: 10.1097/01.ta.0000196436.95569.a3. | |
| 16988308 | Background | Dissmann PD, Han KH. The tuning fork test--a useful tool for improving specificity in "Ottawa positive" patients after ankle inversion injury. Emerg Med J. 2006 Oct;23(10):788-90. doi: 10.1136/emj.2006.035519. |
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| Buffalo Rule |
| Procedure |
As previously published |
|
| Ottawa Ankle and Foot Rules + application of a tuning fork to the distal fibula and tibia | Procedure | As previously published |
|
| Thompson Test | Procedure | As previously published |
|
| Palpation of the fibula | Procedure | Palpation of the fibula over its entire length. |
|
| Ottawa Ankle and Foot Rules + palpation of the cuboid bone | Procedure | As previously published |
|
| Ottawa Ankle and Foot Rules + palpation over the deltoid ligament | Procedure | As previously published |
|
| Malleolar Zone Algorithm | Procedure | As previously published |
|
| Low Risk Exam | Procedure | As previously published |
|
| Bernese Ankle Rules | Procedure | As previously published |
|
| Ottawa Ankle and Foot Rules + swelling of the distal fibula | Procedure | As previously published |
|
The prevalence of gastrocnemius tendon rupture in ankle trauma has, to the best of our knowledge, not yet been quantified. |
| At the first visit to the emergency department |
| 11782648 | Background | Leddy JJ, Kesari A, Smolinski RJ. Implementation of the Ottawa ankle rule in a university sports medicine center. Med Sci Sports Exerc. 2002 Jan;34(1):57-62. doi: 10.1097/00005768-200201000-00010. |
| 1554175 | Background | 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. doi: 10.1016/s0196-0644(05)82656-3. |
| 15231460 | Background | Dayan PS, Vitale M, Langsam DJ, Ruzal-Shapiro C, Novick MK, Kuppermann N, Miller SZ. Derivation of clinical prediction rules to identify children with fractures after twisting injuries of the ankle. Acad Emerg Med. 2004 Jul;11(7):736-43. doi: 10.1197/j.aem.2004.02.517. |
| 11784626 | Background | Boutis K, Komar L, Jaramillo D, Babyn P, Alman B, Snyder B, Mandl KD, Schuh S. Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study. Lancet. 2001 Dec 22-29;358(9299):2118-21. doi: 10.1016/S0140-6736(01)07218-X. |
| 12698029 | Background | Clark KD, Tanner S. Evaluation of the Ottawa ankle rules in children. Pediatr Emerg Care. 2003 Apr;19(2):73-8. doi: 10.1097/00006565-200304000-00003. |
| ID | Term |
|---|---|
| D016512 | Ankle Injuries |
| ID | Term |
|---|---|
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
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