Ottawa Ankle Rule

Why did you develop the Ottawa Ankle Rule? Was there a clinical experience that inspired you to create this rule for clinicians?

We found that emergency doctors were ordering many imaging studies for ankle injuries that were then found to be normal. I thought if there were a set a rules with criteria developed by emergency physicians, for emergency physicians, they would help this problem and shorten emergency department wait times and costs.

What pearls, pitfalls and/or tips do you have for users of the Ottawa Ankle Rule? Are there cases when it has been applied, interpreted, or used inappropriately?

As a general rule in the emergency department, x-rays are rarely useful because most injuries are soft tissue, and an x-ray does not show ligament injury.

What recommendations do you have for health care providers once they have applied the Ottawa Ankle Rule besides imaging, or when imaging is negative?

If the rule states imaging is required, rarely does a patient need both an ankle and foot x-ray, just one or the other or neither. If negative, most patients will heal quickly from a soft tissue ankle injury, but some may require physical therapy.

What are some situations in which you see clinicians interpreting the rule improperly or incorrectly leading to inappropriate x-ray utilization?

Sometimes doctors don't properly assess the patient's ability to bear weight on their injured ankle. Most patients can and will walk, but it may take a little encouragement from the physician.

Ian Stiell, MD, MSc, FRCPC, is Professor and Chair, Department of Emergency Medicine, University of Ottawa; Distinguished Professor and University Health Research Chair, University of Ottawa; Senior Scientist, Ottawa Hospital Research Institute; and Emergency Physician, The Ottawa Hospital. He is internationally recognized for his research in emergency medicine with a focus on the development of clinical decision rules and the conduct of clinical trials involving acutely ill and injured patients treated by prehospital services and in emergency departments. He is best known for the development of the Ottawa Ankle Rule, the Canadian C-Spine Rule, and Canadian CT Head Rule and as the Principal Investigator for the landmark OPALS Studies for prehospital care. Dr. Stiell is the Principal Investigator for 1 of 3 Canadian sites in the Resuscitation Outcomes Consortium (ROC) which is funded by CIHR, NIH, HSFC, AHA, and National Defence Canada. Dr. Stiell is a Member of the Institute of Medicine of the U.S. National Academies of Science.

To read more about Dr. Stiell's work, visit his website.