Low Risk Rule Cuts Use of X-Rays in Child Ankle Injuries
(HealthDay News) – Introduction of the Low Risk Ankle Rule in emergency departments significantly reduces the rate of pediatric ankle radiography, according to research published online Aug. 12 in CMAJ, the Journal of the Canadian Medical Association.
Kathy Boutis, MD, of the University of Toronto, and colleagues conducted a phased implementation of the Low Risk Ankle Rule in six Canadian emergency departments (three intervention sites and three matched control sites). The effect of three phases on the frequency of radiography in children with ankle injuries was assessed: phase 1, no intervention; phase 2, physician education, reminders, and a computerized decision support system; and phase 3, decision support system only.
The researchers enrolled 2,151 children with ankle injuries at the intervention (1,055) and control sites (1,096). The baseline frequency of child ankle radiography was similar at the intervention (96.5%) and control (90.2%) hospitals in phase 1. A significantly greater decrease in the use of pediatric ankle radiography was observed at the intervention sites compared with the control sites in phase 2 (between-group difference, −21.9%); this reduction was sustained in phase 3. No significant difference was observed in patient or physician satisfaction between the groups. During its application, the rule had a sensitivity of 100% and a specificity of 53.1%.
"Widespread implementation of this rule could safely lead to reduction of unnecessary radiography in this radiosensitive population and a more efficient use of health care resources," the authors write.