NDLI: Can clinical prediction rules used in acute pediatric ankle and midfoot injuries be applied to an adult population?

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Can clinical prediction rules used in acute pediatric ankle and midfoot injuries be applied to an adult population?

Year: 2011 Volume: 29 Issue: 3

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Year: 2008 Volume: 26

Can clinical prediction rules used in acute pediatric ankle and midfoot injuries be applied to an adult population?

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Smith, Kimberly R. Brown, Charles K. Brewer, Kori L.
Description	Country affiliation: United States Author Affiliation: Smith KR ( Department of Emergency Medicine, The Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.)
Abstract	BACKGROUND: Almost every patient who comes to an emergency department (ED) with the chief complaint of ankle or foot pain will receive a radiograph, but less than 15% will have a finding positive for ankle or midfoot fracture. In an effort to reduce the number of radiographs performed, clinicians have attempted to derive a set of maximally sensitive clinical prediction rules. Dayan et al (Acad Emerg Med. 2004;11(7):736-745) in 2004 derived a set of such rules for children. These rules have not yet been evaluated in the adult population. OBJECTIVE: The objective of this study is to apply the existing clinical prediction rules used to identify children with fractures after twisting injuries of the ankle to a population that includes adults. METHODS: This was a prospective observational study using convenience sampling. Patients older than 2 years presenting to the ED or associated urgent care center with the chief complaint of an ankle or foot injury were considered eligible for enrollment into the study. After informed consent was obtained, 11 physical examination variables were assessed. Radiographs were obtained and reported, and the radiograph results were noted on the patient's data sheet. Based on the radiograph results, sensitivity and specificity of each of the physical examination variables were analyzed. RESULTS: Sixty-eight patients were eligible, and 29 patients were enrolled after exclusion criteria were applied (median age, 34 years). Three patients were diagnosed with a malleolar zone fracture, and 2 patients were diagnosed with a midfoot zone fracture. Five indicators were found to be 100% sensitive for ankle fracture, and 2 indicators were 100% sensitive for midfoot fracture. CONCLUSIONS: The same indicators found to be predictive of high risk for fracture in a population of pediatric patients were found to be predictive in a population including adults.
File Format	HTM / HTML
ISSN	07356757
Issue Number	4
Volume Number	29
e-ISSN	15328171
Journal	The American Journal of Emergency Medicine
Language	English
Publisher	Elsevier
Publisher Date	2011-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Emergency Discipline Medicine Ankle Injuries Decision Support Techniques Emergency Service, Hospital Foot Bones Injuries Foot Injuries Fractures, Bone Adolescent Adult Age Factors Child Cohort Studies Female Humans Male Predictive Value Of Tests Radiography Young Adult Journal Article
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine

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