Validation of the Ottawa Ankle Rules at a Tertiary Teaching Hospital
Bibliographic record
Abstract
Background: Ankle joint and foot injuries are among the most common injuries seen at the accident and emergency (A&E) department of any hospital. Radiographs are ordered in over 95% of cases yet the prevalence of fractures is in the range of 15-20%. The Ottawa ankle rules have been designed to reduce the need for radiographs in these patients and associated healthcare costs. This study aimed to validate the Ottawa ankle rules within our local setting and assess the impact of introduction of the rules. Methods: This was a cross sectional study at the Aga Khan University Hospital A&E department and the orthopedic outpatient clinics. Consenting patients with ankle trauma were examined based on the criteria set out in the Ottawa rules and subsequently sent for radiographs to confirm the presence or absence of a fracture. Results: The study recruited 175 patients over a six month period. There were 27 fractures with an incidence of 15%. The decision rule had a sensitivity of 96.3% and specificity of 57.4%. The negative predictive value was 98.8%. Application of these rules showed a potential of reducing the requested radiographs by 46%. Conclusion: The results have shown that implementation of the rules will result in significant savings in cost, time and unnecessary radiation exposure. Keywords: Ottawa Ankle Rules, Radiographs, Predictive Value, Healthcare Costs.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".