ReviewEffectiveness of emergency nurses’ use of the Ottawa Ankle Rules to initiate radiographic tests on improving healthcare outcomes for patients with ankle injuries: A systematic review
Section snippets
What is already known about the topic?
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It is difficult to distinguish an ankle strain or sprain from a fracture without radiographic assistance so that radiographic tests are requested for most patients with ankle injuries, although only a small proportion of these patients have actually sustained fractures.
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The Ottawa Ankle Rules provide guidelines for clinicians on the recommendation of radiographic tests to verify fractures in patients with ankle injuries.
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The implementation of the Ottawa Ankle Rules by emergency nurses has been
What this paper adds
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The implementation of the refined Ottawa Ankle Rules by emergency nurses was found to minimise unnecessary radiographic-test requests and reduce patients length of stay in emergency departments, but did not reduce unnecessary radiographic-test requests or patients length of stay in an urgent-care department.
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The implementation of the refined Ottawa Ankle Rules by emergency nurses with different backgrounds, including nurse practitioners and general emergency nurses was found to reduce patients
Background
Ankle injuries are common among emergency-department patients. Approximately 15% of 117 million emergency-department patients in the United States report lower-extremity injuries (Niska et al., 2010). The ankle is the second most common area of lower-extremity injury (20%), and the most common types of ankle injury are strain and sprain (72%) (Lambers et al., 2012). It is difficult to distinguish an ankle strain or sprain from a fracture without radiographic assistance (Singh-Ranger and
Aim
The aim of the systematic review was to synthesise the most accurate information available on the extent to which emergency nurses’ use of the OARs to initiate radiographic tests improves healthcare outcomes for patients with ankle injuries.
Design
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to identify essential components of the review.
Eligibility criteria
The participants of interest were patients (≥1 year old) who visited emergency or urgent care departments to obtain
Retrieval and selection of studies
The processes of retrieving and selecting the studies are depicted in Fig. 1. A search of databases and other sources yielded 1603 records, with 1584 in English and 19 in Chinese. After removing duplicates, 1406 records were screened. The eligibility of 17 full-text articles was assessed, and nine were found to meet the inclusion criteria. Eight full-text articles were excluded because of irrelevant types of participants, interventions, outcome measures, or studies. All nine studies were
Radiographic-test requests
Pooled analysis of the results reported by Allerston and Justham (2000b), Lee et al. (in press) and Mann et al. (1998) implies that the use of the OARs by emergency nurses can minimise the proportion of radiographic-test requests in emergency departments. Similarly, the results reported by Gwilym et al. (2003) imply that the use of the OARs by medical and nursing staff minimises the proportion of radiographic-test requests in emergency departments.
Lau et al. (2013) and Salt and Clancy (1997)
Conclusions
This systematic review summarises the best available evidence of the extent to which emergency nurses’ use of the OARs to initiate radiographic tests improves the healthcare outcomes for patients with ankle injuries. The implementation of the refined OARs by emergency nurses was found to minimise unnecessary radiographic-test requests and reduce patients’ length of stay in emergency departments, but did not reduce unnecessary radiographic-test requests or patients’ length of stay in an
Conflicts of interest
None declared.
Sources of funding
None declared.
Ethical approval
None.
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