Ottawa Ankle Rules: Adequacy of clinical information in X-ray referrals for traumatic ankle injury

Ankle and foot injuries are the most commonly presented musculoskeletal injuries in Australian emergency departments,1 with 4667 such presentations in South Australia in 2017–2018.2 The Ottawa Ankle Rules (OAR) are part of a clinical decision-making tool to help clinicians accurately rule out ankle fractures and hence preclude the need for diagnostic X-ray imaging of ankle trauma.3 This instrument has a sensitivity of almost 100% across various studies.3 The rules state that ankle X-rays are only required if the patient experiences malleolar pain and bone tenderness of the posterior distal tibia/medial malleolus tip, the posterior distal fibula/lateral malleolus tip or an inability to weight bear for four steps both immediately and in the emergency department.4In this study, we undertook a retrospective clinical audit of 300 ankle imaging referrals to (i) assess the current usage of the OAR in ruling out ankle fractures in a major metropolitan emergency department in Australia; (ii) evaluate the current concordance rate of scoring with positive findings on radiography and (iii) report on referring trends between professions, including consultants, registrars, physiotherapists and nurse practitioners. Ethics review was not sought because the study met criteria for exemption from such review according to an institutional policy.The outcome measures are characteristics of the included patients, compliance rate with the OAR, overall prevalence of ankle fractures, referring trends and sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of the OAR in this study. Formal results are pending but will be available at time of presentation.