Original Articles
Effect of the Low Risk Ankle Rule on the frequency of radiography in children with ankle injuries
Kathy Boutis, Paul Grootendorst, Andrew Willan, Amy C. Plint, Paul Babyn, Robert J. Brison, Arun Sayal, Melissa Parker, Natalie Mamen, Suzanne Schuh, Jeremy Grimshaw, David Johnson and Unni Narayanan
CMAJ August 12, 2013 cmaj.122050; DOI: https://doi.org/10.1503/cmaj.122050
Kathy Boutis
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Paul Grootendorst
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Andrew Willan
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Amy C. Plint
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Paul Babyn
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Robert J. Brison
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Arun Sayal
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Melissa Parker
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Natalie Mamen
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Suzanne Schuh
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Jeremy Grimshaw
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
David Johnson
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.
Unni Narayanan
Division of Emergency Medicine (Boutis, Parker, Schuh), Department of Pediatrics, Hospital for Sick Children, University of Toronto; Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Grootendorst), McMaster University, Hamilton, Ont.; Hospital for Sick Children Research Institute (Willan), University of Toronto, and Dalla Lana School of Public Health, Toronto, Ont.; Division of Emergency Medicine (Plint), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Radiology (Babyn), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Brison), Kingston General Hospital, Kingston, Ont.; Department of Emergency Medicine (Sayal), North York General Hospital, Toronto, Ont.; Divisions of Critical Care and Emergency Medicine (Parker), Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ont.; Department of Emergency Medicine (Mamen), Toronto East General Hospital, East York, Ont.; Clinical Epidemiology Program (Grimshaw), Ottawa Health Research Institute, Ottawa Ont.; Division of Emergency Medicine (Johnson), Department of Pediatrics, Alberta Children's Hospital, Calgary Alta.; Department of Orthopedics (Narayanan), Hospital for Sick Children, Toronto, Ont.