Validation of the Ottawa ankle rules in France: A study in the surgical emergency department of a teaching hospital

Study objective: To validate the Ottawa ankle rules to predict fractures in a French clinical setting when they are used by physicians not involved in their development. Methods: We used a prospective patient survey by emergency physicians in a surgical emergency department of a university teaching hospital of the Assistance Publique-Hopitaux de Paris. The study group consisted of 416 consecutive patients aged 18 years and older who presented with acute ankle or midfoot injuries in the surgical ED during a if-month period. Radiography was performed in each patient after clinical evaluation findings were recorded. Results: Forty-nine ankle and 22 midfoot fractures were diagnosed. The decision rules had a sensitivity of.98, a specificity of.45, and a negative predictive value of.99 in detecting ankle fractures, a sensitivity of 1.0, a specificity of.29, and a negative predictive Value of 1.0 in detecting midfoot fractures. The rules failed to predict one avulsion fracture in the ankle group. Application of these rules by emergency physicians would have reduced ankle or midfoot radiography requests by 33%. Conclusion: Use of the Ottawa ankle rules by French emergency physicians not involved in the rules' development resulted in 99% sensitivity and had a potential of reducing radiography requests by 33%.