The American journal of emergency medicine
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A pooled analysis was conducted of the seven studies on the clinical diagnostic effectiveness of the Ottawa ankle rules when used with adult patients in the emergency department (ED). The seven studies, conducted in university and community hospital EDs, had examined the sensitivity, specificity, and positive and negative predictive values of the Ottawa ankle rules. ED physicians applied the Ottawa ankle rules with adult patients who had blunt ankle injuries. ⋯ Thus, the Ottawa ankle rules should not be used for ruling in a fractured ankle or foot. This pooled analysis shows the Ottawa ankle rules to be effective as clinical practice guidelines for acute ankle and foot injuries in the adult ED patient. Patients with negative results when the rules are used are highly unlikely to have a fractured ankle or foot, but the diagnosis for positive patients is much less certain, suggesting the need for radiography.
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This study was conducted to describe the utilization of plain radiography in the initial evaluation of shoulder pain in the emergency department (ED) and assess the feasibility of developing guidelines for the selective use of shoulder radiographs by determining whether clinical variables are able to discriminate between subjects having therapeutically informative versus uninformative X-rays. The study was a chart review of all adult ED patients presenting to the Boston University Medical Center Hospital (Boston, MA) between January 1994 and January 1996 with a chief complaint that included shoulder pain. Subjects with X-rays were classified into two groups, those with therapeutically informative X-rays (ie, identified conditions requiring specific therapy) and those with therapeutically uninformative X-rays (ie, did not result in specific therapy). ⋯ These data show that X-rays for the initial evaluation of shoulder pain in the ED are overutilized. This preliminary model suggests that clinical variables are able to distinguish between patients with informative versus uninformative X-rays. Prospective studies are needed to derive valid decision rules for selective use of shoulder radiographs in the ED.
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Letter Case Reports
Vertebral artery dissection following chiropractic manipulation.