Freins à l’utilisation des critères d’Ottawa dans les traumatismes de cheville : enquête auprès de médecins généralistes

Abstract

IntroductionSprained ankle is the most common injury both within the sport community and the general population as a whole (6000 a day in France alone). Dr Stiell Canadian team has put together a set of rules to determine the need of X-raying for an ankle trauma: the Ottawa rules. Sensitivity is close to 100%. It has been shown that these rules are not applied in general practice. The main object of this study is to find out what prevents the application of the Ottawa rules by surveying local general practitioners (GPs). MethodThe qualitative study has allowed for the semi-conducted and recorded interviews with GPs in Corbeil-Essonnes and its surrounds, none with additional training above basic medicine. Feedback has been obtained and analyzed. ResultsSixteen GPs have been interviewed to obtain overall complete data. The Ottawa rules are not applied as they are most often unknown. Facing the context of medico-legal insurances, pressure from patient and/or doctor's concern and anxiety, given the practician's lack of availability, treatment of the trauma varies according to the time of day, other factors include the doctor's experience and the specific of the patients profile resulting in the non application of the Ottawa rules. ConclusionNone of the reasons mentioned above are acceptable as the Ottawa rules are clinical rules of high sensitivity. They simplify diagnosis, lead to a reduction of health costs and lower the use of X-ray on patients. However, there is no known recommendation from the National French Health Authority to adopt the Ottawa rules. If they were to be applied, it may provide a medico-legal framework for the treatment of ankle traumas. More work on communication and patient/doctor relationship would also reduce the unnecessary use of X-ray. A poster and fliers campaign by the Health Insurance would raise awareness in GPs and patients alike on this subject.