Ottawa rules meta-analysis

Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review

Bachmann LM, Kolb E, Koller MT, et al. BMJ (Clinical research ed.) 2003 · PMID 12595378 · doi:10.1136/bmj.326.7386.417

Question

How accurately do the Ottawa ankle rules exclude fractures of the ankle and midfoot across different settings?

Design

Systematic review and meta-analysis of diagnostic accuracy studies.

Patients

Adults and children with acute ankle or midfoot injuries in multiple countries.

Intervention

Ottawa ankle rules

Comparison

Radiography as reference standard

Primary outcome

Pooled sensitivity and negative likelihood ratios (specificity was not pooled)

Key result

Sensitivity was almost 100% with low negative likelihood ratios for ankle and midfoot in adults and children, so a negative rule makes fracture very unlikely; specificity was only modest.

Limitations

Heterogeneity between studies in setting and application of the rules; some included studies were of limited quality.

Impact on practice

Confirms the rules can be used confidently to rule out fracture and reduce unnecessary radiographs in emergency care.