Audit on the use of radiography and the management of ankle sprains in A&E

Abstract

Objective: To determine the need for a local implementation strategy of the Ottawa Ankle and Foot rule in the A& E Department of St. Luke' s Hospital, Malta and to examine the current management practices of ankle sprains. Methods: A prospective study was conducted on all patients aged 16 years and over presenting to the A& E department of St. Luke’s Hospital, Malta over a six week period with ankle and midfoot injuries. Data collected included time and mechanism of injury, clinical examination findings, radiographic investigations ordered, management and disposal of patient. Results: Sixty nine (95%) of the 73 patients presenting with ankle injuries underwent x-ray investigation. In total 90 x-ray series (i.e. AP and lateral) were performed, 62 of which were ankle x-rays and 28 were foot x-rays. Clinical application of the Ottawa ankle rules (OAR) would have resulted in a reduction of ankle x-rays by 19.4% and foot x-rays by 32.1%. Management of severe ankle sprains included written discharge instructions in 54% and referrals to physiotherapy in 31%. One patient out of the 13 with severe ankle sprains was given a follow up appointment at Fresh Trauma Clinic (FTC). Conclusion: A local implementation strategy for the OAR in the A& E department may result in an overall reduction in radiographic requests by 21%. An appropriate guideline for management of ankle injuries incorporating the OAR is needed and should be developed using the available evidence base.