Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review
Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review
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DOI：
10.1136/bmj.326.7386.417
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发表时间：
2003-02-22
影响因子：
105.7
通讯作者：
ter Riet, G
中科院分区：
文献类型：
--
作者：
Bachmann, LM;Kolb, E;ter Riet, G
目的总结渥太华踝关节规则的准确性的证据，排除骨折的踝关节和中foot.Design系统评价的决策援助。数据来源电子数据库，包括研究的参考列表，和experts.Review方法数据提取的研究人群，渥太华踝关节规则的类型，和方法。在检查受试者工作特征图后，使用自助法合并敏感性，但不合并特异性。负似然比汇总为几个亚组，纠正四个主要的方法学威胁validity.Results 32项研究符合纳入标准和27项研究报告的15 581例患者被用于荟萃分析。踝关节和足中部的合并阴性似然比分别为0.08（95%置信区间0.03至0.18）和0.08（0.03至0.20）。两个地区儿童的合并阴性似然比为0.07（0.03至0.18）。应用这些比率，骨折的患病率为15%，实际骨折的概率小于1.4%，在这些subgroup.Conclusion证据支持渥太华踝关节规则作为一个准确的工具，排除骨折的踝关节和中足。该仪器具有几乎100%的灵敏度和适度的特异性，它的使用应减少30- 40%的不必要的X线照片的数量。
Objective To summarise the evidence on accuracy of the Ottawa ankle rules, a decision aid for excluding fractures of the ankle and mid-foot.Design Systematic review.Data sources Electronic databases, reference lists of included studies, and experts.Review methods Data were extracted on the study population, the type of Ottawa ankle rules used, and methods. Sensitivities, but not specificities, were pooled using the bootstrap after inspection of the receiver operating characteristics plot. Negative likelihood ratios were pooled for several subgroups, correcting for four main methodological threats to validity.Results 32 studies met the inclusion criteria and 27 studies reporting on 15 581 patients were used for meta-analysis. The pooled negative likelihood ratios for the ankle and mid-foot were 0.08 (95% confidence interval 0.03 to 0.18) and 0.08 (0.03 to 0.20), respectively. The pooled negative likelihood ratio for both regions in children was 0.07 (0.03 to 0.18). Applying these ratios-to a 15% prevalence of fracture gave a less than 1.4% probability of actual fracture in these subgroups.Conclusion Evidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40%.