Ottawa ayak bileði kurallarýnýn ülkemizde devlet hastanesi acil servisinde görevli pratisyen hekimler tarafýnca kullanýmý

AMAÇ: Ottawa ayak bileði kurallarýnýn ülkemizde devlet hastanesinde görevli pratisyen hekimler tarafýnca kullanýlmasýnýn etkinliðini araþtýrmak.
GEREÇ VE YÖNTEM: Ýki yüz yataklý devlet hastanesi ikinci basamak acil servise, ayak-ayakbileði travmasý ile müracaat eden 405 hasta çalýþmaya dahil edildi. Tüm hastalar pratisyen hekim tarafýnca muayene edilerek Ottawa pozitif veya negatif olarak sýnýflandýrýldý. Tüm hastalara ön-arka ve yan, ayak ve ayak bileði grafisi çekildi. Grafiler, hastanýn Ottawa grubunu bilmeyen ortopedi ve radyoloji uzmanlarýnca deðerlendirilerek klinik olarak anlamlý kýrýk olup olmadýðý saptandý. Takiben sonuca göre Ottawa ayakbileði kuralý için duyarlýlýk, özgüllük, pozitif ve negatif kestirim deðerleri hesaplandý.
BULGULAR: Ýki yüz elli bir (%61.97) hasta Ottawa (+), 154 hasta (%38.02) Ottawa (–) olarak saptandý. Altmýþ iki (%15.3) hastada klinik olarak anlamlý kýrýk tespit edildi. Kýrýk olan 62 hastanýn 61’inde (%98.4) Ottawa (+) idi. Deplase olmamýþ birinci metatars kýrýðý tespit edilen bir (%1.6) hastada Ottawa (–) idi. Bununla birlikte kýrýk saptanmayan 190 (%55.4) hasta Ottawa (+), 153 (%44.6) hasta Ottawa (–) idi (p<0.001). Duyarlýlýk, özgüllük, pozitif ve negatif kestirim deðerleri sýrasýyla %98.39, %44.61, %24.30 ve %99.35 idi. Eðri altýnda kalan alan 0.71 olarak hesaplandý. Bu sonuçlara göre Ottawa ayakbileði kurallarýnýn olasý radyolojik tetkik azaltma oraný %38.02 olarak tespit edildi.
TARTIÞMA: Ottawa ayak bileði kurallarý (OAR) akut ayak bileði ve ayak orta bölüm yaralanmalarý geçiren hastalarda yüksek derecede duyarlý tarama testidir. Ýyi eðitimli pratisyen hekimlerin OAR’yi uygulamasý çekilen radyogramlarýn sayýsýnýn anlamlý derecede azalmasýný saðlayarak, hasta ve personelin zamandan tasarruf saðlamasýna ek olarak tedavi maliyetini ve radyasyona maruziyeti de azaltýr.

Implementation of the Ottawa ankle rules by general practitioners in the emergency department of a Turkish district hospital

BACKGROUND: The present objective was to assess implementation of the Ottawa ankle rules (OAR) as a method of fracture prediction in the emergency department (ED) of a Turkish state hospital.
METHODS: Patients who presented to the ED of our hospital with acute ankle injury were evaluated. All were examined by a general practitioner, after which a series of ankle and foot x-rays (anteroposterior and lateral) were performed. Radiography was examined by a radiologist and an orthopedic surgeon, both of whom were blinded to OAR results. Radiographic results were compared to results of OAR implementation. Sensitivity and specificity of the OAR in the diagnosis of fracture was calculated.
RESULTS: A total of 251 (61.97%) patients were diagnosed as positive (+) for fracture after OAR implementation, 154 (38.02%) as negative (–). Clinically significant fracture was detected in 62 (15.3%) patients. A total of 61 (98.4%) patients with significant fracture were OAR (+); 1 (1.6%) was OAR (–). However, 190 (55.4%) patients without fracture were OAR (+); 153 (44.6%) were OAR (–) (p<0.001). Sensitivity, specificity, and positive and negative predictive values of OAR implementation in the prediction of fracture were 98.39%, 44.61%, 24.30%, and 99.35%, respectively. Area under the curve (AUC) was 0.71. According to these results, it was determined that use of radiography could be reduced by 38.02% if the OAR were implemented.
CONCLUSION: The OAR are a highly sensitive means of screening of patients with acute ankle and mid-foot injuries. Application of the OAR by well-trained general practitioners can lead to significant reduction in the number of x-rays performed, thereby reducing cost of treatment and radiation exposure, in addition to saving time for patients and staff.