Diagnostic accuracy of clinical decision rules to exclude fractures in acute ankle injuries: systematic review and meta-analysis

Ingrid Barelds, Wim P Krijnen, Johannes P van de Leur, Cees P van der Schans, Robert J Goddard

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

BACKGROUND: Ankle decision rules are developed to expedite patient care and reduce the number of radiographs of the ankle and foot. Currently, only three systematic reviews have been conducted on the accuracy of the Ottawa Ankle and Foot Rules (OAFR) in adults and children. However, no systematic review has been performed to determine the most accurate ankle decision rule.

OBJECTIVES: The purpose of this study is to examine which clinical decision rules are the most accurate for excluding ankle fracture after acute ankle trauma.

METHODS: A systematic search was conducted in the databases PubMed, CINAHL, PEDro, ScienceDirect, and EMBASE. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of the included studies were calculated. A meta-analysis was conducted if the accuracy of a decision rule was available from at least three different experimental studies.

RESULTS: Eighteen studies satisfied the inclusion criteria. These included six ankle decision rules, specifically, the Ottawa Ankle Rules, Tuning Fork Test, Low Risk Ankle Rule, Malleolar and Midfoot Zone Algorithms, and the Bernese Ankle Rules. Meta-analysis of the Ottawa Ankle Rules (OAR), OAFR, Bernese Ankle Rules, and the Malleolar Zone Algorithm resulted in a negative likelihood ratio of 0.12, 0.14, 0.39, and 0.23, respectively.

CONCLUSION: The OAR and OAFR are the most accurate decision rules for excluding fractures in the event of an acute ankle injury.

Original languageEnglish
Pages (from-to)353-368
JournalJournal of emergency medicine
Volume53
Issue number3
DOIs
Publication statusPublished - 1 Sep 2017

Keywords

  • ankle fractures
  • ankle injuries
  • decision support techniques
  • severity of illness index

Cite this

@article{38ac8e5b9b6e4a1e98db191776159ffd,
title = "Diagnostic accuracy of clinical decision rules to exclude fractures in acute ankle injuries: systematic review and meta-analysis",
abstract = "BACKGROUND: Ankle decision rules are developed to expedite patient care and reduce the number of radiographs of the ankle and foot. Currently, only three systematic reviews have been conducted on the accuracy of the Ottawa Ankle and Foot Rules (OAFR) in adults and children. However, no systematic review has been performed to determine the most accurate ankle decision rule.OBJECTIVES: The purpose of this study is to examine which clinical decision rules are the most accurate for excluding ankle fracture after acute ankle trauma.METHODS: A systematic search was conducted in the databases PubMed, CINAHL, PEDro, ScienceDirect, and EMBASE. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of the included studies were calculated. A meta-analysis was conducted if the accuracy of a decision rule was available from at least three different experimental studies.RESULTS: Eighteen studies satisfied the inclusion criteria. These included six ankle decision rules, specifically, the Ottawa Ankle Rules, Tuning Fork Test, Low Risk Ankle Rule, Malleolar and Midfoot Zone Algorithms, and the Bernese Ankle Rules. Meta-analysis of the Ottawa Ankle Rules (OAR), OAFR, Bernese Ankle Rules, and the Malleolar Zone Algorithm resulted in a negative likelihood ratio of 0.12, 0.14, 0.39, and 0.23, respectively.CONCLUSION: The OAR and OAFR are the most accurate decision rules for excluding fractures in the event of an acute ankle injury.",
keywords = "ankle fractures, ankle injuries, decision support techniques, severity of illness index, enkelblessures, diagnostiek",
author = "Ingrid Barelds and Krijnen, {Wim P} and {van de Leur}, {Johannes P} and {van der Schans}, {Cees P} and Goddard, {Robert J}",
note = "Copyright {\circledC} 2017 Elsevier Inc. All rights reserved.",
year = "2017",
month = "9",
day = "1",
doi = "10.1016/j.jemermed.2017.04.035",
language = "English",
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Diagnostic accuracy of clinical decision rules to exclude fractures in acute ankle injuries : systematic review and meta-analysis. / Barelds, Ingrid; Krijnen, Wim P; van de Leur, Johannes P; van der Schans, Cees P; Goddard, Robert J.

In: Journal of emergency medicine, Vol. 53, No. 3, 01.09.2017, p. 353-368.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Diagnostic accuracy of clinical decision rules to exclude fractures in acute ankle injuries

T2 - systematic review and meta-analysis

AU - Barelds, Ingrid

AU - Krijnen, Wim P

AU - van de Leur, Johannes P

AU - van der Schans, Cees P

AU - Goddard, Robert J

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - BACKGROUND: Ankle decision rules are developed to expedite patient care and reduce the number of radiographs of the ankle and foot. Currently, only three systematic reviews have been conducted on the accuracy of the Ottawa Ankle and Foot Rules (OAFR) in adults and children. However, no systematic review has been performed to determine the most accurate ankle decision rule.OBJECTIVES: The purpose of this study is to examine which clinical decision rules are the most accurate for excluding ankle fracture after acute ankle trauma.METHODS: A systematic search was conducted in the databases PubMed, CINAHL, PEDro, ScienceDirect, and EMBASE. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of the included studies were calculated. A meta-analysis was conducted if the accuracy of a decision rule was available from at least three different experimental studies.RESULTS: Eighteen studies satisfied the inclusion criteria. These included six ankle decision rules, specifically, the Ottawa Ankle Rules, Tuning Fork Test, Low Risk Ankle Rule, Malleolar and Midfoot Zone Algorithms, and the Bernese Ankle Rules. Meta-analysis of the Ottawa Ankle Rules (OAR), OAFR, Bernese Ankle Rules, and the Malleolar Zone Algorithm resulted in a negative likelihood ratio of 0.12, 0.14, 0.39, and 0.23, respectively.CONCLUSION: The OAR and OAFR are the most accurate decision rules for excluding fractures in the event of an acute ankle injury.

AB - BACKGROUND: Ankle decision rules are developed to expedite patient care and reduce the number of radiographs of the ankle and foot. Currently, only three systematic reviews have been conducted on the accuracy of the Ottawa Ankle and Foot Rules (OAFR) in adults and children. However, no systematic review has been performed to determine the most accurate ankle decision rule.OBJECTIVES: The purpose of this study is to examine which clinical decision rules are the most accurate for excluding ankle fracture after acute ankle trauma.METHODS: A systematic search was conducted in the databases PubMed, CINAHL, PEDro, ScienceDirect, and EMBASE. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of the included studies were calculated. A meta-analysis was conducted if the accuracy of a decision rule was available from at least three different experimental studies.RESULTS: Eighteen studies satisfied the inclusion criteria. These included six ankle decision rules, specifically, the Ottawa Ankle Rules, Tuning Fork Test, Low Risk Ankle Rule, Malleolar and Midfoot Zone Algorithms, and the Bernese Ankle Rules. Meta-analysis of the Ottawa Ankle Rules (OAR), OAFR, Bernese Ankle Rules, and the Malleolar Zone Algorithm resulted in a negative likelihood ratio of 0.12, 0.14, 0.39, and 0.23, respectively.CONCLUSION: The OAR and OAFR are the most accurate decision rules for excluding fractures in the event of an acute ankle injury.

KW - ankle fractures

KW - ankle injuries

KW - decision support techniques

KW - severity of illness index

KW - enkelblessures

KW - diagnostiek

UR - http://www.mendeley.com/research/diagnostic-accuracy-clinical-decision-rules-exclude-fractures-acute-ankle-injuries-systematic-review

U2 - 10.1016/j.jemermed.2017.04.035

DO - 10.1016/j.jemermed.2017.04.035

M3 - Review article

VL - 53

SP - 353

EP - 368

JO - Journal of emergency medicine

JF - Journal of emergency medicine

SN - 0736-4679

IS - 3

ER -