Ankle Trauma in Children, Application of Ottawa Ankle Rules From 5 Years Old, What is the Impact

Ankle Trauma in Children, Application of Ottawa Ankle Rules From 5 Years Old, What is the Impact

Ankle sprain in children is a very common pathology. Currently in France, a standard X-ray is done in almost all cases. However, the literature has for several years validated the consideration of the Ottawa ankle rules in children to avoid the realization of these X-rays.

Our study is an evaluation of clinical practice. The aim is to assess the impact of the implementation of a new protocol using the Ottawa ankle rules from the age of 5. In particular, radiographic sparing and absence of diagnostic error.

Main objective: To compare the rate of X-rays performed before and after implementation of the protocol in pediatric emergencies.

Secondary objectives (if applicable):

• Compare the time spent in the emergency room of patients before and after implementation of the protocol
• Evaluate the gain in terms of cost for the healthcare system
• Evaluate the adherence of caregivers to compliance with the protocol
• Evaluate the decrease in the rate of X-rays performed in different age groups.
• Evaluation of the consultation rate in the month for the same reason

Primary endpoint = X-ray rate as a % of X-rays performed on the number of children presenting to pediatric emergencies over the period studied (before implementation of the protocol in a similar period = May to October 2022 / after implementation of the protocol = May to October 2023) Secondary endpoints =

• Time spent in the emergency room in min
• Estimation of the cost for the healthcare system by taking the cost of an x-ray and evaluating the gain on the reduction in the rate of x-rays performed (number of x-rays - cost of an x-ray)
• Evaluation of caregiver compliance by measuring the number of X-rays performed outside the protocol (X-ray performed despite the absence of Ottawa criteria)
• X-ray rate by age group
• Spontaneous reconsultation rate within 1 month

Inclusion Criteria:

• 5 to 18 years old
• consulting in pediatric emergency in Nancy children hospital
• for ankle injury

Exclusion Criteria:

Constitutional bone disease Polytrauma Inability to assess the patient (inebriated, altered consciousness, neurosensitive disease, intoxication) Non-acquired walking Injury more than 10 days old Patient re-consults for the same injury previously assessed in the same centre Patient with previous radiographs prior to consultation Open fracture Sensory or vascular deficit Haemophilia Metabolic disease with proven osteopenia