A Prospective Study Comparing Different Clinical Decision Rules in Adult and Pediatric Ankle Trauma (LEFO)

• Sensitivity for detection of significant fractures [ Time Frame: At the first visit to the emergency department ] [ Designated as safety issue: Yes ]
  • In the adult population: fractures of the ankle, midfoot or fibula with a fragment measuring > 3mm detected by radiography
  • In the pediatric population: fractures of the ankle, midfoot or fibula with a fragment measuring > 3mm detected by radiography. Salter-Harris I and II are not considered to be significant fractures. Due to considerable controversy in the literature sensitivity and specificity of the clinical decision rules will be calculated separately for different definitions of significant fractures.
  
  
• Specificity for detection of significant fractures [ Time Frame: At the first visit to the emergency department ] [ Designated as safety issue: No ]
  • In the adult population: fractures of the ankle, midfoot or fibula with a fragment measuring > 3mm detected by radiography
  • In the pediatric population: fractures of the ankle, midfoot or fibula with a fragment measuring > 3mm detected by radiography. Salter-Harris I and II are not considered to be significant fractures. Due to considerable controversy in the literature sensitivity and specificity of the clinical decision rules will be calculated separately for different definitions of significant fractures.
  
  

• Prevalence of proximal fibula fractures in ankle trauma [ Time Frame: At the first visit to the emergency department ] [ Designated as safety issue: No ]
  The prevalence of proximal fibula fractures in ankle trauma has, to the best of our knowledge, not yet been quantified.
  
  
• Prevalence of gastrocnemius tendon rupture in ankle trauma [ Time Frame: At the first visit to the emergency department ] [ Designated as safety issue: No ]
  The prevalence of gastrocnemius tendon rupture in ankle trauma has, to the best of our knowledge, not yet been quantified.
  
  

Patients with ankle trauma frequently present in the emergency department. In many institutions radiographies of the ankle and foot are obtained in most of these patients, although significant fractures occur only in 15%. Therefore clinical decision rules were developed to clinically rule out significant ankle fractures, thereby reducing the number of radiographies resulting in significant time and cost savings.

Up until now the Ottawa Ankle and Foot Rules are the only clinical decision rules for ankle trauma that are widely accepted. They have a high sensitivity for the detection of fractures but a relatively low specificity. This led to the development of alternative clinical decision rules claiming equally high sensitivity but improved specificity. These alternatives have mostly not been replicated nor have they been directly compared.

This is what the researchers want to do in this study: compare different clinical decision rules regarding sensitivity and specificity. Radiographies of ankle and foot made for every patient are used as the gold standard for the detection of fractures.

Different clinical decision rules will be compared in a pediatric (5-15 years) and an adult population (from 16 years onwards). The researchers consider a clinical decision rule acceptable of it has a sensitivity of at least 95% and a specificity of at least 25%.