Accident and Emergency Academic List <[log in to unmask]> wrote:
I think it would be interesting to set up study, using the same observer and the same patient, several days apart.
You know the small subgroup of patients who have been perfectly adequately treated on day one but like to come back on day three/four to tell you it's better, but not completely better yet? I find it not at all unusual to find this group to be "Ottawa +ve" on second presentation, having been documented as "Ottawa -ve" a few days previously. It then comes down to how much you trust the initial assessment whether or not to x-ray.
Gerry Mc Carthy
Cork
<
< I agree with the finding, 24 hours after the injury the punter seems to
< have posterior malleolar tenderness. I can't remember from the original
< papers from Ottawa whether there was a time limit on the patients, theres
< early dementia for you.
< I haven't seen any papers myself on timecourse of symptoms, it seems not to
< be a feature in most studies.
< Any one out there want to do the work?
< The numbers will need a multisite study I imagine
<
< Andy Volans
< Scarborough
< >
< >It's been my clinical impression over the years that patients attending
< >with ankle injuries over 24 hrs are more likely to need an X ray using
< >the Ottawa guidelines. However the pick up rate for fractures seems >less.
< There are three possible reasons for this:
< >
< >a) swelling and inflammation spreads over the time period, so that pain
< >on palpation that was initially limited spreads to the posterior aspect
< >of the lateral malleolus.
< >
< >b) I'm seeing a self selected group who present late.
< >
< >c) it's a false observation.
< >
< >I wonder has any paper serially examined the injured ankles on a daily
< >basis to note any change in the clinical signs thus triggering an
< >"indication" for X Ray?
< >
< >
< >Ray McGlone
< >
< >A&E Consultant
< >Lancaster
< >
< >
< >
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