engleski

Unnecessary ankle series in emergency department - 20 years after Ottawa rules

The aim of this study is to raise the awareness of many unnecessary imaging procedures taken daily in our emergency department (ED). We focused on ankle series because ankle injuries are relatively common, amounting to around 10% of all injuries registered in Croatian hospitals. It is estimated that 80% to 98% of patients reporting to emergency rooms with injuries to the ankle, midfoot, or both undergo radiography during evaluation, but fewer than 15% of these patients have a significant fracture. This leads to additional health care costs, causes prolonged stay at emergency department and, finally, unnecessary irradiation of the patient. Ottawa ankle rules present a simple, free-of-charge and effective diagnostic method that can recognize patients with indication for ankle X-ray imaging, thus avoiding unnecessary radiographic procedures. We conducted a small survey among total of 12 physicians in our emergency department, aiming to establish most common reasons for radiography in ankle injuries, as well as implementation of Ottawa ankle rules in everyday practice. Also, a survey on a sample of 112 patients referred to ankle radiography in period from October 2015 to January 2016 was conducted, with goal of determining if a fracture was present and if the radiologist considered that the imaging was indicated. The results have shown that only 27.68% of examined patients had radiographically visible fracture involving one or more ankle bones. However, radiologists examining the images considered that the imaging was justified in 71.43% of the patients, based on patient’s history from the ED. The survey has shown that all of the participants agree that some patients undergo radiography although a fracture could have been excluded by physical examination only. The lack of clear guidelines and hospital protocol are considered to be two main reasons for unnecessary imaging. The vast majority of survey participants (83.33%) still doesn’t use the Ottawa ankle rules in everyday practice. We hope that this study will raise the awareness of unnecessary radiographic examinations, and encourage hospitals to implement the Ottawa rules and other methods that can help to reduce unnecessary radiation exposure in their ED protocols, if they haven’t already done so.

Clinical Decision Support ; Imaging Referral Guidelines

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