The role of Ottawa Ankle Rules and expansion of nurse-initiated x-ray of lower limbs in a paediatric emergency department
Bibliographic record
Abstract
Aim: To identify if a nurse-initiated x-ray guideline for upper limbs at Princess Margaret Hospital for Children (PMH) could be expanded to include lower limbs utilising the Ottawa Ankle Rules (OAR). Background: The OAR are a clinical decision rule validated in adult populations to determine the need for x-ray in injuries of the mid-foot and ankle. Literature suggests that the OAR can be validated in paediatric populations. With support for nurse-initiated x-ray, this quality improvement project investigated the expansion of nurse-initiated x-ray of lower limbs. Design: A quality improvement project by methods of retrospective chart review and benchmarking activity between tertiary paediatric hospital emergency departments (ED) within Australia. Results: The retrospective chart review had limited findings due to its methodology. The benchmarking activity revealed support for the expansion of nurse-initiated x-rays to include lower limbs. There were two hospitals in the benchmarking activity, which utilised the OAR in nurse-initiated x-ray to include lower limbs. Conclusion: PMH does not have a nurse-initiated x-ray guideline for lower-limbs. Further research is required to develop the expansion of the PMH guideline for nurse-Initiated x-ray in the ED, to be consistent with the current practices of other tertiary paediatric EDs in Australia.
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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 | 0.041 | 0.177 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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 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".