Utilidad de las reglas de Ottawa para tobillo y medio pie en Atención Primaria. Validez (I)

Abstract

ObjectiveTo demonstrate the applicability of the Ottawa rules (OR) for ankle and mid foot in Primary Care and its ability in reducing the number of unnecessary radiographs, by designing a validity study. Material and methodsA descriptive and cross-sectional study was conducted on a sample of 72 patients with ankle and middle foot traumas who met the inclusion criteria and enrolled consecutively in a Primary Care setting from 1 December 2013 to 30 April 2014. The OR was applied and radiographs taken on all patients regardless of the outcomes. Calculation of sensitivity (S), specificity (E), positive and negative predictive value (PPV and NPV), positive and negative likelihood ratios (LR+ and LR−). ResultsThe validity of the OR was analysed separately for ankle and midfoot. Acute ankle trauma (AAT): S: 75 %, E: 84.4 %, PPV: 30 %, NPV: 97.4 %, LR(+): 4.89 and LR(−) 0.3. Acute midfoot trauma (AMFT): S: 100 %, E: 64.7 %, PPV: 50 %, NPV: 100 %, LR(+): 2.83, LR(−): 0. A pooled analysis resulted in: S: 90 %, E: 79 %, PPV: 41 %, NPV: 98 %, LR(+): 4 and LR(−): 0.13. ConclusionsOR are valid and useful in Primary Care to select patients with AAT and AMFT who do not need radiographs, which would reduce the total amount of them by 68%. The probability of having a fracture with a negative test is very low (1 in 100).