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Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7386.417 (Published 22 February 2003) Cite this as: BMJ 2003;326:417

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  • Medline Premedline

    Table A
     

    Example of search strategy

    Medline Premedline

    Search command

    1 ottawa.mp. [mp=ti, ab, rw, sh]

    2 ankle$2.mp. [mp=ti, ab, rw, sh]

    3 1 and 2

    4 *ANKLE INJURIES/di, ra, ec, ep [Diagnosis, Radiography, Economics, Epidemiology]

    5 3 or 4

    6 ANKLE INJURIES/di, ra, ec, ep [Diagnosis, Radiography, Economics, Epidemiology]

    7 exp GUIDELINES/

    8 6 and 7

    9 5 or 8

    Embase

    Search command

    1 OTTAWA.TI,AB.

    2 ANKLE$

    3 1 AND 2

    4 (C2-580-500-490-495-50# OR ANKLE-INJURY.DE..W.)

    5 (ANKLE-INSTABILITY.DE..W.)

    6 4 5

    7 (J2-50-700# OR PRACTICE-GUIDELINE.DE..W.)

    8 6 AND 7

    9 6.MJ.

    10 6 WITH DI

    11 6 WITH EP

    12 (I1-250# OR ECONOMIC-ASPECT.DE..W.)

    13 9 AND 10

    14 9 AND 11

    15 9 AND 12

    16 3 8 13 14 15

    CINAHL

    1 ottawa

    2 ankle*

    3 ottawa with (ankle* in ti,ab)

    4 explode "Ankle-Injuries"/ all topical subheadings / all age subheadings

    5 "Practice-Guidelines"/ all topical subheadings / all age subheadings

    6 "Clinical-Assessment-Tools"/ all topical subheadings / all age subheadings

    7 #6 or #5

    8 #4 and #7

    9 ottawa

    10 #4 and ottawa

    11 #10 or #8 or #3
     

    Table A [As supplied by authors] Description of all 32 studies included in review of accuracy of Ottawa ankle rules
     

    SubgroupsStudy
    Year of publication
    Number of patients
    		Specification
    True positive
    False positive
    False negative
    True negative
    Negative Likelihood Ratio
    Ankle assessmentAginaga
    1999
    463
    		Physicians applied the OARs in adults in a regional hospital setting in Spain
    46
    250
    2
    165
    0.10
     Auleley
    1998
    130
    		Comparison of the radiography request rates between senior house officers and nurse practitioners using the OARs in adults in a university hospital setting in France.
    48
    171
    1
    137
    0.05
     Kerr
    1994
    350
    		OARs applied in a convenience sample of adults of 4 hospitals (2 university hospitals, one community and one provincial) in New Zealand. Mid-foot injuries were not assessed.
    70
    245
    5
    30
    0.61
     Leddy
    2002
    193
    		Validating the "Buffalo modification of the OARs in a sports medical centre in Buffalo, USA:
    17
    96
    0
    80
    0.06
     Lucchesi
    1995
    422
    		OARs in a convenience sample of adult patients of a suburban community teaching trauma centre in USA.
    88
    278
    5
    51
    0.35
     Mann
    1998
    700
    		Comparison of the radiography request rates between senior house officers and nurse practitioners applying the OARs in patients enrolled within 48 hours after injury to a large accident and emergency department in UK. No midfoot assessment Physicians assessment.
    127
    413
    0
    160
    0.01
     Mann
    1998
    1365
    		Comparison of the radiography request rates between senior house officers and nurse practitioners applying the OARs in patients enrolled within 48 hours after injury to a large accident and emergency department in UK. No midfoot assessment Nurses assessment.
    232
    759
    5
    369
    0.06
     Papacostas
    2001
    79
    		OARs in athletes and people sporting at least 3/week injured during sports activities attending a district general hospital and sports injuries clinic in Greece.
    9
    49
    0
    21
    0.17
     Perry
    1999
    577
    		OARs assessed in an urban teaching hospital in UK. No midfoot assessment
    59
    269
    4
    245
    0.13
     Rosin
    1999
    67
    		Retrospective analysis to evaluate the impact of the OARs at a US army troop medical clinic in South Korea
    2
    20
    0
    45
    0.24
     Singh-Ranger
    1999
    18
    		Compare conventional ordering of X-rays to the use of the OARs in a district general hospital in UK. No assessment of midfoot reported.
    3
    5
    0
    10
    0.19
     Solomito
    1994
    631
    		Abstract
    70
    460
    0
    101
    0.04
     Springer
    2000
    157
    		Physiotherapists assessing the "Buffalo" modification of the OARs in a military population attending a community hospital in the USA
    6
    90
    0
    61
    0.18
     Springer
    2000
    157
    		Physicians assessing the "Buffalo" modification of the OARs in a military population attending a community hospital in the USA
    6
    81
    0
    70
    0.15
     Stiell
    1992
    689
    		Development of OARs in two university hospital EDs in Canada
    70
    371
    0
    248
    0.02
     Stiell
    1993
    1032
    		OARs applied in adults attending either one of 2 university hospital EDs in Canada. Refinement of the 1992 rules.
    121
    557
    0
    354
    0.01
     Stiell
    1993
    453
    		OARs applied in adults attending either one of 2 university hospital EDs in Canada. Validation of the refined rules.
    50
    205
    0
    198
    0.02
     Stiell
    1994
    565
    		Implementation study of the OARs using the refined 1993 OARs. OARs applied on adults attending a university hospital in Canada.
    74
    244
    0
    247
    0.01
     Yuen
    2001
    467
    		Validation study to investigate applicability of the OARs in the Chinese population in a district hospital in Hong Kong
    52
    245
    1
    169
    0.05
              
    Foot assessmentAginaga
    1999
    197
    		Physicians applied the OARs in adults in a regional hospital setting in Spain
    26
    141
    0
    30
    0.10
     Auleley
    1998
    130
    		Comparison of the radiography request rates between senior house officers and nurse practitioners using the OARs in adults in a university hospital setting in France.
    22
    77
    0
    31
    0.08
     Leddy
    2002
    24
    		Validating the "Buffalo modification of the OARs in a sports medical centre in Buffalo, USA:
    7
    11
    0
    6
    0.17
     Lucchesi
    1995
    150
    		OARs in a convenience sample of adult patients of a suburban community teaching trauma centre in USA.
    27
    107
    2
    14
    0.60
     Papacostas
    2001
    43
    		OARs in athletes and people sporting at least 3/week injured during sports activities attending a district general hospital and sports injuries clinic in Greece.
    8
    21
    0
    14
    0.15
     Springer
    2000
    154
    		Physiotherapists assessing the "Buffalo" modification of the OARs in a military population attending a community hospital in the USA
    3
    32
    0
    119
    0.16
     Springer
    2000
    154
    		Physicians assessing the "Buffalo" modification of the OARs in a military population attending a community hospital in the USA
    3
    32
    0
    119
    0.16
     Solomito
    1994
    189
    		Abstract
    23
    118
    0
    48
    0.07
     Stiell
    1992
    230
    		Development of OARs in two university hospital EDs in Canada
    32
    149
    0
    49
    0.06
     Stiell
    1993
    1032
    		OARs applied in adults attending either one of 2 university hospital EDs in Canada. Refinement of the 1992 rules.
    48
    294
    1
    689
    0.03
     Stiell
    1993
    453
    		OARs applied in adults attending either one of 2 university hospital EDs in Canada. Validation of the refined rules.
    19
    90
    0
    344
    0.03
     Stiell
    1994
    564
    		Implementation study of the OARs using the refined 1993 OARs. OARs applied on adults attending a university hospital in Canada.
    19
    125
    0
    420
    0.03
     Yuen
    2001
    256
    		Validation study to investigate applicability of the OARs in the Chinese population in a district hospital in Hong Kong
    78
    100
    0
    78
    0.01
              
    Combined assessmentAllerston
    2000
    144
    		Comparison of X-ray request of nurse practitioners and medical practitioners in a county hospital in the UK
    21
    58
    4
    61
    0.31
     Chandra
    2001
    397
    		OARs applied in adult patients attending a city hospital in Germany
    79
    260
    5
    53
    0.35
     Garces
    2001
    494
    		OARs in two community hospitals in Spain.
    54
    368
    2
    70
    0.22
     Glas
    2002
    647
    		Comparison of the OARs and the Leiden ankle rule assessed in adults of a mid-sized teaching hospital in the Netherlands.
    66
    424
    8
    149
    0.42
     Keogh
    1998
    262
    		Comparison of current local guidelines with OARs in patients >16 years attending a teaching hospital in London UK:
    22
    125
    0
    115
    0.05
     Leddy
    1998
    78
    		OARs applied in patients > 12 years, attending a university based community sports medical centre in Buffalo, USA.
    7
    41
    0
    30
    0.15
     Leddy
    1998
    78
    		The "Buffalo" modification of the OARs applied in patients > 12 years, attending a university based community sports medical centre in Buffalo, USA.
    7
    29
    0
    42
    0.11
     McBride
    1997
    259
    		OARs applied in adults attending a common practice setting with family physicians in a community hospital in Canada.
    33
    157
    1
    68
    0.10
     Pigman
    1994
    81
    		Comparative study to assess the validity of the OARs when used at a community and a university hospital setting in the USA by attending physicians and triage nurses. Nurses assessed OARs
    9
    64
    1
    7
    1.01
     Pigman
    1994
    71
    		Comparative study to assess the validity of the OARs when used at a community and a university hospital setting in the USA by attending physicians and triage nurses. Doctors assessed OARs
    9
    50
    0
    12
    0.25
     Salt
    1997
    324
    		OARs used by triage nurses at a university hospital in UK. X-ray was performed on discretion of treating physician.
    48
    190
    0
    86
    0.03
     Tay
    1999
    488
    		OARs in Asian population (Chinese, Malay and Indian) attending a large teaching hospital in Singapore.
    61
    276
    7
    144
    0.30
     Tay
    1999
    488
    		Assessing a modification of the OARs changing the weight bearing item to: no weight bearing possible in Asian population (Chinese, Malay and Indian) attending a large teaching hospital in Singapore.
    67
    283
    1
    137
    0.05
     Verma
    1996
    911
    		OARs applied in adults attending a level 1 trauma centre in the USA.
    152
    607
    1
    151
    0.03
              
    ChildrenBoutis
    2001
    607
    		Comparison of clinical examination with the OARs to identify high-risk diagnoses in children attending either one of 2 urban, university affiliated paediatric emergency departments in Canada.
    74
    463
    0
    70
    0.05
     Chande
    1995
    68
    		OAR applied in paediatric patients enrolled within 48 hours after injury at the University Hospital of Cleveland, USA.
    14
    37
    0
    17
    0.10
     Karpas
    2002
    186
    		Paediatric ED nurses applying the OARs within 48 hours after injury in children attending a tertiary care facility in the USA.
    31
    116
    1
    38
    0.13
     Libetta
    1999
    761
    		OARs applied in children > 1year old, attending a large teaching hospital in UK:
    59
    373
    1
    328
    0.04
     McBride
    1997
    37
    		OARs applied in children attending a common practice setting with family physicians in a community hospital in Canada.
    7
    22
    0
    8
    0.23
     Plint
    1999
    559
    		OARs applied in children attending one of two specialist tertiary care units in Canada within 48 hours after injury, ankle assessment
    67
    375
    0
    117
    0.03
     Plint
    1999
    205
    		OARs applied in children attending one of two specialist tertiary care units in Canada within 48 hours after injury, foot assessment
    17
    121
    0
    67
    0.08

     

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