Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
3000 participants
INTERVENTIONAL
2008-11-30
2011-11-30
Brief Summary
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Therefore, this study will be the first to put the best paediatric ankle x-ray rule, the Low Rick Ankle Rule, into physician practice in EDs. Our main goal is to determine how much we can reduce ankle x-ray rates in EDs that use this rule regularly versus those that do not. If we show that doctors can safely use this rule regularly and the number of ankle x-rays will be significantly less, this will lessen unnecessary potentially harmful radiation exposure in children, these children will spend less time in an ED, and the health care system will save money.
Detailed Description
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Conditions
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Keywords
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Study Design
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NON_RANDOMIZED
PARALLEL
DIAGNOSTIC
NONE
Study Groups
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1
Control Sites
No interventions assigned to this group
2
Intervention Sites
LRAR Implementation
Pre-LRAR - no changes in the usual procedures for the first 26 weeks except for flagging of all paediatric charts with ankle injuries, ED documentation which will not refer to the LRAR and phone follow up.
Post-LRAR: At 27 weeks, in addition to the aforementioned ED collection sheet and phone follow up, the implementation strategy for the LRAR rule and related management will be introduced at the intervention hospitals.
Interventions
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LRAR Implementation
Pre-LRAR - no changes in the usual procedures for the first 26 weeks except for flagging of all paediatric charts with ankle injuries, ED documentation which will not refer to the LRAR and phone follow up.
Post-LRAR: At 27 weeks, in addition to the aforementioned ED collection sheet and phone follow up, the implementation strategy for the LRAR rule and related management will be introduced at the intervention hospitals.
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
2. Children with ankle injuries who returned for reassessment of the same ankle injury.
3. Children with open wounds on their ankle and/or foot
4. All children at risk for pathological fractures such as those with congenital or acquired generalized bony disease (Appendix I). Clinical presentation and risks in these cases may be altered.
5. Congenital anomalies of the feet and/or ankles (eg club feet, tarsal coalition). These abnormalities may have features which may complicate clinical assessment.
6. Patients with known coagulopathies. Underlying hemarthrosis may complicate clinical assessment.
7. Patients with cognitive and/or developmental delay. These patients may not localize pain.
8. Injuries greater than 72 hours old. The signs and symptoms of the most common fracture, the Salter-Harris I fracture of the distal fibula, may be diminished. Our ability to make this clinical diagnosis with confidence may thus be compromised.
9. Recent history of surgery or closed reduction of the same ankle within the last 3 months. These prior events may confuse current presenting symptomatology and ability to weight-bear and recover normally.
10. Patients with low risk injuries who do not have phone or electronic mail access and/or have an insurmountable language barrier. This will preclude follow up.
3 Years
16 Years
ALL
No
Sponsors
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The Hospital for Sick Children
OTHER
Responsible Party
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Kathy Boutis
Staff Physician
Principal Investigators
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Kathy Boutis, MD
Role: PRINCIPAL_INVESTIGATOR
The Hospital for Sick Children
Locations
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Children's Hospital of Eastern Ontario
Ottawa, Ontario, Canada
North York General Hospital
Toronto, Ontario, Canada
The Hospital for Sick Children
Toronto, Ontario, Canada
Toronto East General Hospital
Toronto, Ontario, Canada
Countries
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References
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Boutis K, Grootendorst P, Willan A, Plint AC, Babyn P, Brison RJ, Sayal A, Parker M, Mamen N, Schuh S, Grimshaw J, Johnson D, Narayanan U. Effect of the Low Risk Ankle Rule on the frequency of radiography in children with ankle injuries. CMAJ. 2013 Oct 15;185(15):E731-8. doi: 10.1503/cmaj.122050. Epub 2013 Aug 12.
Boutis K, von Keyserlingk C, Willan A, Narayanan UG, Brison R, Grootendorst P, Plint AC, Parker M, Goeree R. Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments. Ann Emerg Med. 2015 Nov;66(5):455-463.e4. doi: 10.1016/j.annemergmed.2015.05.027. Epub 2015 Jul 14.
Related Links
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Link to Abstract: : Ann Emerg Med. 2015 Nov;66(5):455-
Link to Abstract: Effect of the Low Risk Ankle Rule on the frequency of radiography in children with ankle injuries.
Other Identifiers
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1000012792
Identifier Type: -
Identifier Source: org_study_id