{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:22:21Z","timestamp":1790360541767,"version":"4.1.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2017,10,2]],"date-time":"2017-10-02T00:00:00Z","timestamp":1506902400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJEM"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1481803517003992_abs1\" sec-type=\"general\"><jats:title>Objective<\/jats:title><jats:p>The Ottawa Ankle Rules (OAR) are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. The OAR are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. Limited data support its use by other health care workers in children. Our objective was to determine the accuracy of the OAR when applied by non-physician providers (NPP).<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517003992_abs2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>Children aged 5 to 17 years presenting with an acute ankle or foot injury were enrolled. Phase 1 captured baseline data on x-ray use in 106 patients. NPPs were then educated on the usage of the OAR and completed an OAR learning module. In phase 2, NPPs applied the OAR to 184 included patients.<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517003992_abs3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>The sensitivity of the foot rule, as applied by NPP\u2019s, was 100% (56-100% CI) and the specificity was 17% (9-29% CI) for clinically significant fractures. The sensitivity of the ankle portion of the rule, as applied by NPP\u2019s, was 88% (47-99 CI) and the specificity was 31% (23-40% CI) for clinically significant fractures. The only clinically significant fracture missed by NPP\u2019s was detected on physician assessment. Inter-observer agreement was \u03ba=0.24 for the ankle rule and \u03ba=0.49 for the foot rule.<\/jats:p><\/jats:sec><jats:sec id=\"S1481803517003992_abs4\" sec-type=\"conclusion\"><jats:title>Conclusion<\/jats:title><jats:p>The sensitivity of the OAR when applied by NPP\u2019s was very good. More training and practice using the OAR would likely improve NPP\u2019s inter-observer reliability. Our data suggest the OAR may be a useful tool for NPP\u2019s to apply prior to physician assessment.<\/jats:p><\/jats:sec>","DOI":"10.1017\/cem.2017.399","type":"journal-article","created":{"date-parts":[[2017,10,2]],"date-time":"2017-10-02T02:57:22Z","timestamp":1506913042000},"page":"746-752","source":"Crossref","is-referenced-by-count":11,"title":["Accuracy of the Ottawa Ankle Rules applied by non-physician providers in a pediatric emergency department"],"prefix":"10.1007","volume":"20","author":[{"given":"Joe","family":"MacLellan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teya","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Baserman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Dowling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2017,10,2]]},"reference":[{"key":"S1481803517003992_ref12","doi-asserted-by":"publisher","DOI":"10.1136\/emj.16.5.342"},{"key":"S1481803517003992_ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2016.08.016"},{"key":"S1481803517003992_ref30","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03510350037034"},{"key":"S1481803517003992_ref6","first-page":"943","volume-title":"Br Med J (Clin Res Ed)","volume":"294","author":"Gleadhill","year":"1987"},{"key":"S1481803517003992_ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s10140-002-0207-x"},{"key":"S1481803517003992_ref25","volume-title":"Elementary survey sampling","author":"Scheaffer","year":"1979"},{"key":"S1481803517003992_ref21","doi-asserted-by":"publisher","DOI":"10.1054\/aaen.2000.0103"},{"key":"S1481803517003992_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2015.11.028"},{"key":"S1481803517003992_ref15","doi-asserted-by":"publisher","DOI":"10.1177\/03635465000280061501"},{"key":"S1481803517003992_ref16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2008.00333.x"},{"key":"S1481803517003992_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)07218-X"},{"key":"S1481803517003992_ref20","author":"Dowling","year":"2008"},{"key":"S1481803517003992_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.aenj.2013.05.007"},{"key":"S1481803517003992_ref11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.1999.tb01183.x"},{"key":"S1481803517003992_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2005.02.054"},{"key":"S1481803517003992_ref27","first-page":"315","article-title":"The role of triage nurse ordering on mitigating overcrowding in emergency departments: a systematic review","volume":"15","author":"Rowe","year":"1998","journal-title":"J Accid Emerg Med"},{"key":"S1481803517003992_ref10","article-title":"Validation of the Ottawa Ankle Rules for varus ankle trauma in children: A prospective study of 160 cases. 2004","volume":"86","author":"Dohin","year":"2002","journal-title":"J Bone Joint Surg\u2013British Volume"},{"key":"S1481803517003992_ref2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2015.4114"},{"key":"S1481803517003992_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2009.06.507"},{"key":"S1481803517003992_ref28","doi-asserted-by":"publisher","DOI":"10.1197\/j.aem.2005.04.024"},{"key":"S1481803517003992_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2004.02.001"},{"key":"S1481803517003992_ref26","doi-asserted-by":"publisher","DOI":"10.1197\/aemj.9.2.130"},{"key":"S1481803517003992_ref7","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1001\/jama.269.9.1127","article-title":"Decision rules for the use of radiography in acute ankle injuries. 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