Utility of The Ottawa Rules
The rules have been found to have a very low rate of false negatives. Evidence in systematic reviews supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30–40%.
Among the studies in the original review their research reported that the test was 100% sensitive and reduced the number of ankle X-rays by about 35%. A second trial with a larger number of patients confirmed these findings. Subsequently, a multi-centre study was done that explored the feasibility of implementing the rules on a wider scale. Unfortunately, teaching the rules to patients does not appear to help reduce presentation to hospital.
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