The impact of ankle radiographs on the diagnosis and management of acute ankle injuries

Rationale and Objectives. We assessed the impact of ankle radiographs on referring physicians' diagnoses and treatment of acute ankle injuries. Methods. Twenty emergency department physicians prospectively completed questionnaires before and after radiography on 101 patients with acute trauma receiving ankle radiographs. The questionnaires asked physicians to estimate the probability (0-100%) of their most likely diagnosis before and after receiving the radiographic information. We also asked their anticipated and final treatment plans. We calculated the mean gain in diagnostic confidence percentage and the proportion of patients with changed initial diagnoses or anticipated management. Results. The mean gain in diagnostic certainty from ankle radiographs was 34% (95% confidence interval [CI]=28-40%). Ankle radiographs changed physicians' initial diagnoses in 37% (95% CI=28-47%) of the patients. Immediate clinical management changed in 30% (95% CI=22-40%) of the patients. Conclusion. Plain ankle radiographs have considerable impact on referring physicians diagnoses and treatment of acute ankle trauma.