Staring at my still-wrecked ankle this morning, I’m reminded about the Ottawa Ankle Rules for Ankle Injury Radiography, the poster describing which used to decorate the wall above the Triage desk. The Ottawa Ankle Rules are a rather useful set of guidelines of when to x-ray ankle injuries. As a set of guidelines, it has a high rate of sensitivity (effectively 100%) and reportedly reduced ankle films by 35%. As triage nurses, we can order ankle x-rays under a standing order*, and once upon a time — over ten years ago, anyway — we were trained on using the Rules.
It never really worked in practice, unfortunately; the docs mostly ignored it (and our assessments) and ordered the films regardless. Why? Sometimes patients are persistent in asking for x-rays, for reassurance mostly, and also, frankly, you can’t underestimate the importance of CYA in clinical decision-making. I guess the poster disappeared because no one had used it for years. Too bad: radiography, after all, isn’t trivial. Nor is it free.
*Technically, in Ontario, a medical directive.