Validity of the Ottawa rules for X-ray request in ankle and midfoot injuries in paediatric patients

The aim of the study was to analyse the validity of the Ottawa rules for the X-ray request in A&E for ankle and midfoot injuries in paediatric patients. An observational and prospective study was carried out applying the Ottawa rules to patients attending the Accident and Emergency (A&E) department in Toledo, due to ankle or midfoot injuries from the 1 July 2003 to the 1 February 2004. A total number of 190 patients were included in this study and 29 of these were found to have a fracture. Assessment of the ankle and/or midfoot injuries was made by the orthopaedic junior or senior staff, applying the Ottawa rules. An X-ray request was made for every patient seen, regardless of the Ottawa rules results. The results showed that the sensitivity for the Ottawa rules was 96.9% (95% CI, 94–99.1%). The negative predictive value was 96.6% (95% CI, 96.5–100.1%). The specificity was 36% (95% CI, 29.2–42.9%). The positive predictive value was 21.4% (95% CI, 15.5–27.2%). It can be concluded that The Ottawa rules make up valid instrument for the decision of X-ray request in patients under the age of 18 with ankle and/or midfoot injuries.