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
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
C2 - 28764972
SN - 0736-4679
VL - 53
SP - 353
EP - 368
JO - The Journal of Emergency Medicine
JF - The Journal of Emergency Medicine
IS - 3
ER -