2005, Number 4
Rev Med Inst Mex Seguro Soc 2005; 43 (4)
Palapa GLR, Regla MH
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ABSTRACTObjective: To analyze the usefulness of the rules of Ottawa in the diagnosis of foot and ankle injuries.
Material and methods: To design a diagnostic test. Site: emergency room at Magdalena de las Salinas Trauma Hospital. Participants: adults with injuries of foot and ankle taken care in January 2003. Sampling: non-probabilistic by convenience. Interventions: patients who went for attention due to foot and ankle injuries without evident deformity were asked to went through X-rays, and they were assessed by means of the following criteria: a) pain or increase in sensitivity of the later edge and end of maleolo lateral and medial, in the 6 cm distals; b) pain or increase in the sensitivity of the navicular bone/or base of the fifth metatarsal, and, c) inability to support their weight immediately after the injury and during the physical exploration. The presence of one or more criteria are indicative of X-rays. Measurements: sensitivity, specificity, predictive values (PV), and probability rates (PR).
Results: 50 ankles were studied, correlating the clinical test with the X-rays (gold standard). The clinical test showed a sensitivity of 100 %, specificity of 60 %, PVP of 30 %, PVN of 100 %, RFP of 40 %, and, RFN of 0, PR/RPP of 3, PR/RPN of 0.
Conclusions: In the injuries of ankle, when the Ottawa rules are negative, the X-rays series are not indicated, since the probability of not having a fracture can be of 100 %. When it has one or more criteria, if we asked for the X-rays, a third part of the patients can have fracture with a rate of false positives of 40 %. Apparently, in ankle and foot injuries, certain studies are not essential without having any deterioration of the quality medical care.