RT Journal Article
SR Electronic
T1 Effect of the Low Risk Ankle Rule on the frequency of radiography in children with ankle injuries
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E731
OP E738
DO 10.1503/cmaj.122050
VO 185
IS 15
A1 Boutis, Kathy
A1 Grootendorst, Paul
A1 Willan, Andrew
A1 Plint, Amy C.
A1 Babyn, Paul
A1 Brison, Robert J.
A1 Sayal, Arun
A1 Parker, Melissa
A1 Mamen, Natalie
A1 Schuh, Suzanne
A1 Grimshaw, Jeremy
A1 Johnson, David
A1 Narayanan, Unni
YR 2013
UL http://www.cmaj.ca/content/185/15/E731.abstract
AB Background: The Low Risk Ankle Rule is a validated clinical decision rule that has the potential to safely reduce radiography in children with acute ankle injuries. We performed a phased implementation of the Low Risk Ankle Rule and evaluated its effectiveness in reducing the frequency of radiography in children with ankle injuries.Methods: Six Canadian emergency departments participated in the study from Jan. 1, 2009, to Aug. 31, 2011. At the 3 intervention sites, there were 3 consecutive 26-week phases. In phase 1, no interventions were implemented. In phase 2, we activated strategies to implement the ankle rule, including physician education, reminders and a computerized decision support system. In phase 3, we included only the decision support system. No interventions were introduced at the 3 pair-matched control sites. We examined the management of ankle injuries among children aged 3–16 years. The primary outcome was the proportion of children undergoing radiography.Results: We enrolled 2151 children with ankle injuries, 1055 at intervention and 1096 at control hospitals. During phase 1, the baseline frequency of pediatric ankle radiography at intervention and control sites was 96.5% and 90.2%, respectively. During phase 2, the frequency of ankle radiography decreased significantly at intervention sites relative to control sites (between-group difference −21.9% [95% confidence interval [CI] −28.6% to −15.2%]), without significant differences in patient or physician satisfaction. All effects were sustained in phase 3. The sensitivity of the Low Risk Ankle Rule during implementation was 100% (95% CI 85.4% to 100%), and the specificity was 53.1% (95% CI 48.1% to 58.1%).Interpretation: Implementation of the Low Risk Ankle Rule in several different emergency department settings reduced the rate of pediatric ankle radiography significantly and safely, without an accompanying change in physician or patient satisfaction. Trial registration: ClinicalTrials.gov, no. NCT00785876.