IMPLEMENTATION OF THE OTTAWA ANKLE RULES TO EXCLUDE FRACTURES OF THE ANKLE AND MIDFOOT
Bibliographic record
Abstract
Introduction. Ankle and midfoot injuries are one of the most common orthopaedic complaints, both in the general medicine and the orthopedic practice. The percentage of fractures among these is small, however many of them will undergo an xray. Ottawa ankle rules are clinical guidelines developed for the use of radiography in these cases. This aim of this prospective study was to examine these rules’ implementation in the Israeli emergency medicine department and our ability both to predict a fracture and to reduce the amount of unnecessary xrays. Materials and methods. 92 consecutive patients with ankle injuries attending our emergency medicine department were divided in two groups. Study group included 32 patients who arrived during the morning shift and were examined by an internal medicine specialist according to the Ottawa ankle rules. Patients discharged without an xray were followed in the clinic or by telephone communication. Control group included 60 patients who were examined during the evening and night shifts by orthopedic residents unaware of the study. The mean age in the study group was 24 years and in the control group – 26 years. There was good acceptance of the study in patients of the study group. Only 2 of them insisted on the xrays and were excluded from the study. Rest 30 patients were followed as described. Results. 9 patients (30%) in the study group underwent an xray as opposed to 55 patients (92%) in the control group (p Discussion. The Ottawa ankle rules were developed as a simple “yes/no” decision tool as to whether to xray the ankle. In our emergency department, these rules were proved both accurate and safe. They can be effectively used by professionals not trained in trauma. It can save radiation and patient waiting time without jeopardizing the treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".