Hieb did not mention the use of the "Ottawa Rules
" (see http://www.mdcalc.com/ottawa-ankle-rule/) for the evaluation of ankle, foot, and knee injuries, not necessarily for the avoidance of X-rays, but more for self-triage purposes.
In a systematic review, (2) the Ottawa rules had a pooled negative likelihood ratio (LR-) of 0.05 (95% confidence interval [CI], 0.02-0.23).
Ottawa rules for ankles--yes, but they're good for knees, too The evidence presented here suggests a number of practical and useful approaches for the evaluation of acute knee injury--something that's especially helpful for family physicians and those who, like me, have worked a lot of sporting events.
The Ottawa rules, which can be used to rule out fracture without an x-ray, are fairly well known for ankle injuries, but are not as well known for knees.
Omissions include ignoring the differences between active and passive range of motion, failing to list the Ottawa rules
for X-ray referral, and a limited list of musculoskeletal pathologies.
SEATTLE -- The Ottawa rules
for determining which knee injuries deserve an x-ray to check for a fracture can be applied to children, Dr.
The authors suggested that the Ottawa Rules not be employed in the pediatric population.
Because of the low specificity of the Ottawa Rules (a large number of false-positive results are still obtained), sports medicine physicians at the University of Buffalo determined that a modified set of ankle rules could increase specificity significantly.
Particularly useful segments discuss treatment using typical office supplies; when to obtain radiographs of the ankle (limitations of the Ottawa rules); use of various braces, splints, orthotics, and casts; and differential diagnosis of chronic heel pain and hindfoot problems.
Other lectures describe the physical examination of the foot (7 slides), orthotics (38 slides), acute ankle sprain (35 slides) including the Ottawa rules, and physical therapy of the foot and ankle (18 slides).
Exclusion criteria for the Ottawa rules are: age less than 18; isolated superficial skin injuries; injuries more than 7 days old; recent injuries being reevaluated; and patients with altered levels of consciousness, paraplegia, or multiple injuries.
The individual ED physicians, who determined which patients were included in the study based on their "usual" methods of ordering radiographs, may already have been utilizing the Pittsburgh or Ottawa rules to make decisions.