Reappraisal of the Use of X-Rays in Acute Ankle and Midfoot Injuries. A Prospective Evaluation of the Ottawa Ankle Rules (OAR) in a Single Tertiary Trauma Centre
Bibliographic record
Abstract
INTRODUCTION: Acute ankle and foot injuries commonly present to the emergency departments, often resulting in routine radiography referrals, despite the fact that less than 15% of cases exhibit clinically significant fractures. The OAR has been designed to reduce the number of unnecessary radiographs ordered for these patients. We evaluated the OAR for predicting ankle and midfoot fractures in a cohort of patients treated in a single tertiary trauma centre. MATERIALS AND METHOD: A prospective study was conducted in the emergency department and orthopaedic clinics of a tertiary trauma centre. 73 patients aged 18 years and older were recruited during a 12-month study period. Radiographs were performed for all patients after clinical evaluation findings were recorded. The main outcomes measured were sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios (positive and negative) of the OAR. RESULTS: 41 patients had ankle injuries, 21 around the midfoot, and 11 within both areas. In detecting ankle fractures, OAR had a sensitivity of 100%, a specificity of 73.68%, and a negative predictive value of 100% compared to the detection of midfoot fractures (100%, 84.61%, and 100%, respectively). The OAR had the potential of reducing radiographs by 42.47%. CONCLUSION: OAR is an accurate and highly sensitive tool to detect ankle and midfoot fractures. The implementation would lead to a significant reduction in the request for radiographs without missing any clinically significant fractures, thus, reducing costs, radiation exposures, and waiting times.
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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 | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".