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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(05): 620-624
DOI: 10.1055/s-0040-1702957
Artigo Original
Trauma

Application of the Ottawa Protocol by Medical Students and Orthopedic Residents on Ankle Sprains at a Trauma Hospital[*]

Article in several languages: português | English
José Marcos Lavrador Filho
1   Departamento de Ortopedia e Traumatologia, Hospital do Trabalhador, Curitiba, PR, Brasil
,
Paulo Henrique Vogt 
1   Departamento de Ortopedia e Traumatologia, Hospital do Trabalhador, Curitiba, PR, Brasil
,
Alexandre Roberto Roman Coelho
2   Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná, Curitiba, PR, Brasil
,
Daniel Kyubin Cho
2   Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná, Curitiba, PR, Brasil
,
João Luiz Vieira da Silva
2   Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná, Curitiba, PR, Brasil
,
Patrick Willian Padoani 
3   Departamento de Ortopedia e Traumatologia, Clínica de Fraturas e Ortopedia XV, Curitiba, PR, Brasil
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Abstract

Objective To verify the applicability and agreement of the Ottawa ankle rules applied by medical students and orthopedic residents in a tertiary trauma service thus validating the Ottawa protocol for use on Brazilian soil.

Prospective This was a prospective study, conducted in a tertiary hospital, including all patients with acute torsial trauma of the tibiotarsal joint. The patients underwent ankle and/or foot radiographs, and the questionnaire with the Ottawa ankle rules was applied by academics and, subsequently, by residents. The radiographs were evaluated by on-call orthopedists and specialist in foot and ankle, and the expert opinion was considered the gold standard for analysis.

Results Two hundred and sixty-three patients were evaluated, and, after application of the established inclusion criteria, 226 cases remained for evaluation. The sensitivity to detect lesions and negative predictive value (NPV) was 100%. The most sensitive test with higher NPV for both academics and residents was palpation of the lateral malleolus. The study presented potential for a reduction of 30% in the total number of tests requested.

Conclusion The data showed applicability and agreement between academics and residents, which allows for the validation of the Ottawa protocol in emergency care in Brazil.

Keywords

sprain fracture - ankle - foot - radiography

* Work developed in the Orthopedics and Traumatology Service of the Hospital dos Trabalhadores, Curitiba, PR, Brazil.




Publication History

Received: 13 June 2019

Accepted: 29 November 2019

Article published online:
22 April 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 

  • Referências

  • 1 Wang X, Chang SM, Yu GR, Rao ZT. Clinical value of the Ottawa ankle rules for diagnosis of fractures in acute ankle injuries. PLoS One 2013; 8 (04) e63228
    CrossrefPubMedGoogle Scholar
  • 2 Waterman BR, Belmont Jr PJ, Cameron KL, Deberardino TM, Owens BD. Epidemiology of ankle sprain at the United States Military Academy. Am J Sports Med 2010; 38 (04) 797-803
    CrossrefPubMedGoogle Scholar
  • 3 Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med 1992; 21 (04) 384-390
    CrossrefPubMedGoogle Scholar
  • 4 Barros MV, Reis RS, Hallal PC. Análise de Dados em Sáude. 3rd ed. Londrina: Midiograf; 2012
    Google Scholar
  • 5 Jekel JF, Elmore JG, Katz DL. Introdução à medicina preventiva. In: Jekel JF, Elmore JG, Katz DL. , editores. Epidemiologia bioestatística e medicina preventiva. Porto Alegre: Artmed; 1999: 203-209
    Google Scholar
  • 6 Anis AH, Stiell IG, Stewart DG, Laupacis A. Cost-effectiveness analysis of the Ottawa Ankle Rules. Ann Emerg Med 1995; 26 (04) 422-428
    CrossrefPubMedGoogle Scholar
  • 7 Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003; 326 (7386): 417
    CrossrefPubMedGoogle Scholar
  • 8 Rodrigues P, Rosa I, Campagnolo JL. [Validation of the Ottawa rules for the Portuguese population: a prospective study]. Acta Med Port 2011; 24 (05) 713-718
    PubMedGoogle Scholar
  • 9 Pires R, Pereira A, Abreu-E-Silva G. et al. Ottawa ankle rules and subjective surgeon perception to evaluate radiograph necessity following foot and ankle sprain. Ann Med Health Sci Res 2014; 4 (03) 432-435
    CrossrefPubMedGoogle Scholar
  • 10 Stiell IG, McKnight RD, Greenberg GH. et al. Implementation of the Ottawa ankle rules. JAMA 1994; 271 (11) 827-832
    CrossrefPubMedGoogle Scholar
  • 11 Ashurst JV, Nappe T, Digiambattista S. et al. Effect of triage-based use of the Ottawa foot and ankle rules on the number of orders for radiographic imaging. J Am Osteopath Assoc 2014; 114 (12) 890-897
    CrossrefPubMedGoogle Scholar
  • 12 Kelly AM, Richards D, Kerr L. et al. Failed validation of a clinical decision rule for the use of radiography in acute ankle injury. N Z Med J 1994; 107 (982) 294-295
    PubMedGoogle Scholar