OTTAWA RULES

Which is more effective when decision making for x-raying ankle injuries Ottawa rules or clinical judgement?

Which is more effective when decision making for x-raying ankle injuries: Ottawa rules or clinical judgement?

Introduction

Clinical decision-making rules are tools designed to assist physicians. They have the definite potential to significantly reduce health care costs while maintaining the optimum level of patient care. In trauma care, it has been demonstrated that the use of clinical rules was able to decrease the need for radiography after ankle trauma without significant inconvenience.

Rationale

It was observed that nurse Practitioners strictly follow evidence based practice by following guide lines, polices and protocols when dealing with injuries like using Ottawa Ankle rules when dealing with decision making of x-rays for ankle injuries. But in comparison doctors do not strictly follow Ottawa rules but they use their clinical judgement along with Ottawa rules in taking decision in sending patient to x-ray . In year 2008 -2009 statistics shows ; Nurse Practitioners had 14 missed fractures and doctors had only 5 missed fractures . Due to this all the re-called patients were dissatisfied with Nurses treatment and some Claimed as Negligence of nurse. The hospital had to pay to patients who claimed nearly £250.000 . It seems that the evidence based practice is better by practicing guidelines and Ottawa rules but along with this clinician judgement is better . For nurses we need that freedom in treating patients . This will increase clinical effectiveness and cost effective .

Ottawa Ankle Rules

It is common to order radiographs for almost every ankle and foot injuries in Emergency Department (ED). However, only less than 15% of patients have fracture. Ottawa Ankle Rules (OAR) is a world wide well-validated and well accepted clinical practice guideline (CPG) to assess these injuries in making the decision for the need of radiographs. It has shown 100% sensitivity with 40.1% specificity(McBride 2009 459-465. Springer Tenuta Taylor 2000 864-868). The final aim would be reducing unnecessary radiographs. This can reduce patient's time in ED and unnecessary radiation exposure. The work load of a radiographer in performing it and an ED doctor in reviewing and interpretating the radiographs can also be reduced. Finally, the total healthcare cost will be reduced without an increased rate of missed fracture. It is not clear whether this decision rule would be useful in British practice. Clinical decision aids aim to guide diagnosis or treatment by integrating a small set of easily accessible clinical information. The prototype example for such a decision aid is the Ottawa Ankle Rule (OAR) to reduce the number of unnecessary x-rays in patients presenting with acute ankle sprain. The OAR states that ankle series radiographs are only indicated if there is any pain in the ankle region, and if there is either bone tenderness along the distal 6 cm of the posterior edge or the tip of either malleolus or inability to bear weight (4 steps) immediately after the injury and in the Emergency Department (ED). 

The Ottawa ankle rules are a series of guidelines used by physicians when evaluating patients with foot and ankle pain to determine ...