Ottawa ankle and foot rules in China: applicability in a defensive environment
Bibliographic record
Abstract
BACKGROUND: The introduction of any new diagnostic method in a specific clinical setting and culture requires considerable caution, as sensitivity and specificity may be significantly affected. Whether the Ottawa ankle and foot rules (OAFR) are feasible in the Chinese environment is controversial. This study gauges attitudes and calculates the sensitivity and specificity of OAFR in mainland China. METHODS: Short surveys were designed and disseminated to explore the perspective of emergency department trauma doctors and non-medical personnel towards OAFR. We conducted a prospective study at three hospital sites (one-level two hospital and two-level three hospitals) in three provinces. Documentation of OAFR outcomes was recorded in all patients with acute ankle and mid-foot injuries who presented to the three hospitals if they met the inclusion criteria. Anteroposterior and lateral radiographs of the ankle and/or foot were obtained for all patients based on the site of injury. All images were subsequently reviewed by a well-trained radiologist who was blinded to both the OAFR documentation and the emergency physician's interpretation. Radiographic results were compared with fracture prediction based on OAFR to calculate sensitivity and specificity in our patient population. Positive and negative predictive values were also calculated. RESULTS: Only 31.5% of trauma doctors claimed to have heard of OAFR before, and 19.5% of them knew them in detail. 69.5% considered that department leadership in support of a strict interpretation of the rules would assist in their implementation. Both doctors and patients cited potential missed fractures as the dominant concern regarding the application of OAFR. 88.0% of non-medical persons claimed that they could accept the doctor's opinion if made based on these rules. Those with higher educational attainment would be more likely to accept the doctor's opinion. Overall sensitivity was 98.4% and specificity was 26.3%, for detecting fractures in acute ankle and mid-foot injuries. Four fractures out of 602 patients were missed based on OAFR, with one displaced 2nd and 3rd metatarsal fracture resulting in surgery. CONCLUSIONS: OAFR sensitivity in China is as high as in non-Asian populations. Their use is feasible and could be promoted to limit the unnecessary consumption of scare health resources. Survey data suggests implementation could be accepted by most doctors and patients, but would be hampered by the currently fragile doctor-patient relationship.
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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 | 0.016 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 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 | 0.002 |
| 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".