A Prospective Study Comparing Different Clinical Decision Rules in Adult and Pediatric Ankle Trauma

NCT ID: NCT01205841

Last Updated: 2010-09-21

Study Results

Results pending

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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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

1500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-09-30

Study Completion Date

2012-08-31

Brief Summary

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Comparison of the reliability of different examination techniques to detect fractures in patients with ankle trauma.

Detailed Description

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Patients with ankle trauma frequently present in the emergency department. In many institutions radiographies of the ankle and foot are obtained in most of these patients, although significant fractures occur only in 15%. Therefore clinical decision rules were developed to clinically rule out significant ankle fractures, thereby reducing the number of radiographies resulting in significant time and cost savings.

Up until now the Ottawa Ankle and Foot Rules are the only clinical decision rules for ankle trauma that are widely accepted. They have a high sensitivity for the detection of fractures but a relatively low specificity. This led to the development of alternative clinical decision rules claiming equally high sensitivity but improved specificity. These alternatives have mostly not been replicated nor have they been directly compared.

This is what the researchers want to do in this study: compare different clinical decision rules regarding sensitivity and specificity. Radiographies of ankle and foot made for every patient are used as the gold standard for the detection of fractures.

Different clinical decision rules will be compared in a pediatric (5-15 years) and an adult population (from 16 years onwards). The researchers consider a clinical decision rule acceptable of it has a sensitivity of at least 95% and a specificity of at least 25%.

Conditions

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Ankle Injuries

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Adults

Patients from 16 years of age onwards

Group Type EXPERIMENTAL

Ottawa Ankle and Foot Rules

Intervention Type PROCEDURE

As previously published

Buffalo Rule

Intervention Type PROCEDURE

As previously published

Ottawa Ankle and Foot Rules + application of a tuning fork to the distal fibula and tibia

Intervention Type PROCEDURE

As previously published

Thompson Test

Intervention Type PROCEDURE

As previously published

Palpation of the fibula

Intervention Type PROCEDURE

Palpation of the fibula over its entire length.

Bernese Ankle Rules

Intervention Type PROCEDURE

As previously published

Children

Patients aged 5 to 15 years

Group Type EXPERIMENTAL

Ottawa Ankle and Foot Rules

Intervention Type PROCEDURE

As previously published

Buffalo Rule

Intervention Type PROCEDURE

As previously published

Ottawa Ankle and Foot Rules + application of a tuning fork to the distal fibula and tibia

Intervention Type PROCEDURE

As previously published

Thompson Test

Intervention Type PROCEDURE

As previously published

Palpation of the fibula

Intervention Type PROCEDURE

Palpation of the fibula over its entire length.

Ottawa Ankle and Foot Rules + palpation of the cuboid bone

Intervention Type PROCEDURE

As previously published

Ottawa Ankle and Foot Rules + palpation over the deltoid ligament

Intervention Type PROCEDURE

As previously published

Malleolar Zone Algorithm

Intervention Type PROCEDURE

As previously published

Low Risk Exam

Intervention Type PROCEDURE

As previously published

Bernese Ankle Rules

Intervention Type PROCEDURE

As previously published

Ottawa Ankle and Foot Rules + swelling of the distal fibula

Intervention Type PROCEDURE

As previously published

Interventions

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Ottawa Ankle and Foot Rules

As previously published

Intervention Type PROCEDURE

Buffalo Rule

As previously published

Intervention Type PROCEDURE

Ottawa Ankle and Foot Rules + application of a tuning fork to the distal fibula and tibia

As previously published

Intervention Type PROCEDURE

Thompson Test

As previously published

Intervention Type PROCEDURE

Palpation of the fibula

Palpation of the fibula over its entire length.

Intervention Type PROCEDURE

Ottawa Ankle and Foot Rules + palpation of the cuboid bone

As previously published

Intervention Type PROCEDURE

Ottawa Ankle and Foot Rules + palpation over the deltoid ligament

As previously published

Intervention Type PROCEDURE

Malleolar Zone Algorithm

As previously published

Intervention Type PROCEDURE

Low Risk Exam

As previously published

Intervention Type PROCEDURE

Bernese Ankle Rules

As previously published

Intervention Type PROCEDURE

Ottawa Ankle and Foot Rules + swelling of the distal fibula

As previously published

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Pain due to blunt trauma to the ankle
* Must be at least 5 years old

Exclusion Criteria

* Skin defects in the injured area
* Time of trauma \> 72 hours before presentation
* Multiple significant injuries making clinical examination impossible
* Clinically obvious fracture
* Re-evaluation
* Referred with radiography
* Result of radiography already known to investigator
* Glasgow Coma Scale \< 15
Minimum Eligible Age

5 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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KU Leuven

OTHER

Sponsor Role lead

Responsible Party

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Emergency Department of the University Hospitals, Catholic University Leuven

Principal Investigators

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Dimitri Vandoninck, MD

Role: PRINCIPAL_INVESTIGATOR

Emergency Department of the University Hospitals, Catholic University Leuven

Marc Sabbe, MD, PhD

Role: STUDY_DIRECTOR

Emergency Department of the University Hospitals, Catholic University Leuven

Locations

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Emergency Department of the University Hospitals, Catholic University Leuven

Leuven, Vlaams-Brabant, Belgium

Site Status

Countries

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Belgium

Central Contacts

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Dimitri Vandoninck, MD

Role: CONTACT

+32 479 744 845

Marc Sabbe, MD, PhD

Role: CONTACT

+32 16 343927

Facility Contacts

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Marc Sabbe, MD, PhD

Role: primary

+32 16 343927

Lea Van Roelen

Role: backup

+32 16 343927

References

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Eggli S, Sclabas GM, Eggli S, Zimmermann H, Exadaktylos AK. The Bernese ankle rules: a fast, reliable test after low-energy, supination-type malleolar and midfoot trauma. J Trauma. 2005 Nov;59(5):1268-71. doi: 10.1097/01.ta.0000196436.95569.a3.

Reference Type BACKGROUND
PMID: 16385314 (View on PubMed)

Dissmann PD, Han KH. The tuning fork test--a useful tool for improving specificity in "Ottawa positive" patients after ankle inversion injury. Emerg Med J. 2006 Oct;23(10):788-90. doi: 10.1136/emj.2006.035519.

Reference Type BACKGROUND
PMID: 16988308 (View on PubMed)

Leddy JJ, Kesari A, Smolinski RJ. Implementation of the Ottawa ankle rule in a university sports medicine center. Med Sci Sports Exerc. 2002 Jan;34(1):57-62. doi: 10.1097/00005768-200201000-00010.

Reference Type BACKGROUND
PMID: 11782648 (View on PubMed)

Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992 Apr;21(4):384-90. doi: 10.1016/s0196-0644(05)82656-3.

Reference Type BACKGROUND
PMID: 1554175 (View on PubMed)

Dayan PS, Vitale M, Langsam DJ, Ruzal-Shapiro C, Novick MK, Kuppermann N, Miller SZ. Derivation of clinical prediction rules to identify children with fractures after twisting injuries of the ankle. Acad Emerg Med. 2004 Jul;11(7):736-43. doi: 10.1197/j.aem.2004.02.517.

Reference Type BACKGROUND
PMID: 15231460 (View on PubMed)

Boutis K, Komar L, Jaramillo D, Babyn P, Alman B, Snyder B, Mandl KD, Schuh S. Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study. Lancet. 2001 Dec 22-29;358(9299):2118-21. doi: 10.1016/S0140-6736(01)07218-X.

Reference Type BACKGROUND
PMID: 11784626 (View on PubMed)

Clark KD, Tanner S. Evaluation of the Ottawa ankle rules in children. Pediatr Emerg Care. 2003 Apr;19(2):73-8. doi: 10.1097/00006565-200304000-00003.

Reference Type BACKGROUND
PMID: 12698029 (View on PubMed)

Other Identifiers

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S52510

Identifier Type: -

Identifier Source: org_study_id