Unnecessary ankle series in emergency department - 20 years after Ottawa rules

Congress:

EuroSafe Imaging 2016

Poster Number:

ESI-0023

Type:

EuroSafe Imaging

Keywords:

Action 1 - Clinical decision support, clinical imaging guidelines, Action 1 - Guidelines, implementation policies, and Clinical Decision Support (ESR iGuide)

Authors:

G. Ivanac, E. Divjak, B. Brkljacic

DOI:

10.1594/esi2016/ESI-0023

DOI-Link:

https://dx.doi.org/10.1594/esi2016/ESI-0023

$Fig. 1: Ottawa ankle rules: pain on palpation of posterior edge or tip of lateral or medial malleolus (red) can be a sign of a fracture.$

Fig. 1: Ottawa ankle rules: pain on palpation of posterior edge or tip of lateral or...

$Fig. 2: An example of an avulsion fracture of the medial malleolus.$

Fig. 2: An example of an avulsion fracture of the medial malleolus.

$Fig. 3: An example of a fracture of the medial malleolus.$

Fig. 3: An example of a fracture of the medial malleolus.

Background/Introduction

The aim of this study is to raise the awareness of many unnecessary imaging procedures taken daily in our emergency department. We focused on ankle series because ankle injuries are relatively common – according to Croatian health service yearbook for year 2014, fractures of lower leg, including ankle, amount to 10% of all injuries registered in Croatian hospitals [1]. It is estimated that 80% to 98% of patients reporting to emergency rooms with injuries to the ankle, midfoot or both undergo radiography during evaluation, but...

Description of activity and work performed

METHODS: We retrospectively reviewed reports and images of 112 random patients who had been referred to ankle radiography from October 2015 to January 2016 due to ankle injury. Based on patient’s history from the ED, the authors noted if they found the imaging was necessary or not. Presence or absence of fracture of ankle bones (Figures 2-4) was also noted and the results were expressed as both absolute numbers and relative percentages. A survey about reasons of unnecessary imaging of the ankle and use of...

Conclusion and Recommendations

Ankle injuries are a frequent reason for reporting to ED. Most of the patients undergo radiography of the ankle although a fracture could be excluded in a significant number of cases based on an appropriate physical examination. In this short study, we demonstrated that fracture was found in only 27.68% of patients that underwent imaging. This is a higher percentage than those mentioned in literature [2, 6], maybe because our study was performed in the colder part of the year, when risk of fall is...

Personal/Organisational information

Gordana Ivanac; [email protected]; University Hospital Dubrava, Medical School, University of Zagreb, Zagreb/HR

References

[1] Poljičanin T, Benjak T. Croatian Health Service Yearbook 2014. Zagreb: Croatian Institute of Public Health, 2015. http://www.hzjz.hr/wp-content/uploads/2015/12/ljetopis_2014.pdf [2] Jenkin M, Sitler MR, Kelly JD. Clinical usefulness of the Ottawa Ankle Rules for detecting fractures of the ankle and midfoot. J Athl Train. 2010 Sep-Oct;45(5):480-2. doi: 10.4085/1062-6050-45.5.480. http://www.ncbi.nlm.nih.gov/pubmed/20831394 [3] Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21(4): 384–390. http://www.ncbi.nlm.nih.gov/pubmed/1554175 [4] Milne...