Can an EMT Apply the Ottawa Ankle Rules to Patients with Ankle Injury?

ABSTRACT

PURPOSE: The Ottawa ankle rule (OAR) is a clinical decision rule to detect bony injury in patients with a recent ankle injury. We evaluated the ability of emergency medical technicians (EMTs) to accurately apply and interpret the OAR. METHODS: This prospective study was done from October 2009 to February 2010 in a secondary teaching hospital. Patients >18 years of age presenting at the emergency department within 48 hours of a single ankle injury were included. Seven EMTs and three emergency medicine residents were trained in the application of the OAR through one hour educational session prior to this study. They examined the patient's ankle and recorded the data separately. Sensitivity and specificity of the OAR and interobserver agreement using the Kappa statistic were determined. RESULTS: Fifty-one patients were enrolled, mean age was 40.9 years, and 33 (64.7%) were male. Substantial to good agreement were found for all criteria of the OAR (p<0.001). The sensitivity of the OAR was 100% with a specificity of 27.8% in both of them. CONCLUSION: To the best of our knowledge, our study is the first to assess the ability of EMTs working in an emergency center to evaluate and interpret the OAR in adult patients with acute ankle injury. Even less-experienced EMTs can accurately apply and interpret the OAR. The incorporation of the OAR into the EMT's assessment of ankle-injury patients may be a useful physical examination tool for prehospital and hospital triage.