• N. Z. Med. J. · Jul 1994

    Multicenter Study

    Failed validation of a clinical decision rule for the use of radiography in acute ankle injury.

    • A M Kelly, D Richards, L Kerr, J Grant, P O'Donovan, K Basire, and R Graham.
    • Emergency Department Hutt Hospital, Lower Hutt, New Zealand.
    • N. Z. Med. J. 1994 Jul 27;107(982):294-5.

    AimTo validate the Ottawa clinical decision rule for the use of radiography in acute ankle injuries.MethodA prospective, multicentre trial of 350 adult patients presenting with acute ankle injuries consisting of correlation of the features of the Ottawa clinical decision rule with the results of x-rays.ResultsThere were 75 fractures in 350 patients, five of which would have been missed by the clinical decision rule. The sensitivity of the rule was 93% with a specificity of 11%. The positive predictive value was 22%, the false negative rate 14%. Fractures that would have been missed by the clinical decision rule included one unstable fracture of the ankle, one fracture of the talus, one calcaneal fracture and one fracture each of the cuboid and navicular.ConclusionThe Ottawa clinical decision rule for the use of radiography in acute ankle injuries is unacceptable for application in emergency departments in New Zealand due to a high false negative rate.

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