Triage Nurse Initiated Radiographs According to OAR

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01654393
Recruitment Status : Unknown
Verified September 2012 by Dr. Lyne Filiatrault, Vancouver Coastal Health.
Recruitment status was:  Recruiting
First Posted : July 31, 2012
Last Update Posted : September 12, 2012
University of British Columbia
Information provided by (Responsible Party):
Dr. Lyne Filiatrault, Vancouver Coastal Health

July 27, 2012
July 31, 2012
September 12, 2012
July 2012
January 2013   (Final data collection date for primary outcome measure)
Median length of stay (LOS) of patients presenting to a tertiary care academic center with blunt ankle injuries [ Time Frame: 6 months ]
Median LOS will be measured and compared among patients with ankle injuries that were assessed by OAR trained triage nurses who applied the OAR and ordered X-rays if necessary vs those patients who were triaged as per usual practice, with no OAR application.
Same as current
Complete list of historical versions of study NCT01654393 on Archive Site
  • Fracture missed by Triage Nurse: [ Time Frame: Estimated at 6 months. ]
    Assess if fractures were missed by triage nurse via + X-rays ordered by EP or via follow-up questionnaire 2 weeks later to determine if other investigations were performed after the pt's visit to the ED
  • Triage nurses' satisfaction [ Time Frame: estimated at 6 months ]
    Assess triage nurse' feedback regarding comfortability in applying the OAR, training, and whether the OAR has increased workload.
  • Percent agreement regarding necessity for X-ray between emergency nurse and physician [ Time Frame: estimated at 6 months ]
  • Emergency physician's compliance with OAR [ Time Frame: estimated at 6 months ]
    Determine if emergency physicians are applying OAR during this study period
  • Patient satisfaction with triage nurse initiated imaging [ Time Frame: Estimated at 6 months ]
Same as current
Not Provided
Not Provided
Triage Nurse Initiated Radiographs According to OAR
Can Triage Nurse Initiated Radiographs in Accordance With the Ottawa Ankle Rule Shorten Emergency Department Length of Stay At a Tertiary Care Center?
The purpose of the study is to help doctors in emergency departments know whether triage nurse initiated radiographs, in accordance to the Ottawa ankle rule, before emergency physician assessment will shorten emergency patients' visit. The investigators will examine the number of missed fractures between the two groups, the emergency physicians' willingness to apply OAR and triage nurses' satisfaction.

Overcrowding in the emergency department (ED) has been an ongoing issue for many hospitals in North America. Numerous strategies have been implemented and explored in hopes of reducing wait times and length of stay. The Ottawa ankle rules are one such strategy developed and proven to reduce cost and wait time without patient dissatisfaction and missed fractures. As a result, they have gained widespread acceptance from emergency physicians around the world.

Since the implementation of the Ottawa ankle rules (OAR), numerous studies have examined nurses' application and interpretation of these rules. It has been shown that nurses' application of the rule yield similar sensitivity and negative predictability for diagnosis of fractures as physicians. It is believed that emergency nurses can make accurate assessment in the determination of the patients who require radiographs. What is unclear, however, is whether or not triage nurse initiated radiographs shortens patients' length of stay in the emergency department, a factor inversely correlated to patient satisfaction. Only a couple of studies have looked at this issue in the context of the Ottawa ankle rules. One is a retrospective study conducted at an A&E department in a small city while the other, although randomized prospectively, was carried out in an urgent care center rather than in a busy academic tertiary care hospital.

Our primary objective for this study is to investigate the median length of stay of patients presenting to a tertiary care academic center with blunt ankle injuries and assess whether triage nurse initiated radiographs in accordance to the Ottawa ankle rules would shorten their stay versus current standard of care. Presently, the emergency physician orders the x-ray at the time of patient encounter.

Not Applicable
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary Purpose: Health Services Research
Ankle Fracture
Other: Triage nurses applying the OAR
Triage nurses applying the OAR during assessment and ordering foot/ankle x-rays as necessary.
  • Experimental: OAR group
    Patients with ankle injuries who are assessed by OAR trained triage nurses applying the OAR.
    Intervention: Other: Triage nurses applying the OAR
  • No Intervention: Control for OAR Triage Nurses
    Patients with ankle injuries that are seen by OAR triage nurses but not assessed in accordance with the OAR.
Not Provided

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
Unknown status
Same as current
February 2013
January 2013   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Patients aged ≥ 19 presenting with an isolated blunt ankle injury

Exclusion Criteria:

  • Injury >10 days
  • Isolated skin injury
  • Referred patient with outside x-ray
  • Obvious fracture or deformity
  • Polytrauma
  • Pregnancy
  • Diminished sensation due to neurological deficit
  • Uncooperative, intoxicated or patients with altered mental status
  • Patients returning for reassessment of same injury
  • Injury due to or suspicious for domestic violence
Sexes Eligible for Study: All
19 Years and older   (Adult, Older Adult)
Contact information is only displayed when the study is recruiting subjects
Not Provided
Not Provided
Dr. Lyne Filiatrault, Vancouver Coastal Health
Vancouver Coastal Health
University of British Columbia
Principal Investigator: Lyne Filiatrault, MD, FRCPC Vancouver Coastal Health Authorities
Principal Investigator: Wailliam W Lee, MD Vancouver Costal Health Authorities
Principal Investigator: Ryiad Abu-Laban, MD, MHSc, FRCPC Vancouver Costal Health Authorities
Vancouver Coastal Health
September 2012

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP