In medicine, the Ottawa rules are a set of guidelines to help decide whether an X-ray is needed for a patient with foot/ankle, knee and neck pain to diagnose a possible fracture. Before the introduction of the rules most patients with ankle injuries would have had an X-ray. However only about 15% of X-rays were positive for fracture, other patients had sprains or other injuries. As a result many unnecessary X-rays were taken, which was costly, time consuming and a possible health risk.

The Ottawa ankle rules were developed by a team of doctors in the Urgent Care department of the Ottawa Hospital in Ottawa, Canada¹. Since the rules were formulated in Ottawa they were dubbed the Ottawa ankle rules by its creators a few years after their development.

The rules have been found to have a very low rate of false negatives. Evidence in systematic reviews supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40% ²

These are links to the Ottawa rules for ordering X-rays

• Ankle
• Knee
• C-Spine

References:

¹ 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 Apr;21(4):384-90. view online http://www.ncbi.nlm.nih.gov/pubmed/1554175

² http://www.ncbi.nlm.nih.gov/pubmed/12595378




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