Evaluation of Safety and Cost-Effectiveness of the Low Risk Ankle Rule in One of Europe's Busiest Pediatric Emergency Departments. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Ramasubbu, Benjamin; McNamara, Roisin; Okafor, Ike; Deiratany, Samir
• Is Part Of: Pediatric emergency care. Volume 31:Issue 10(2015)
• Publication Date: 2015-10
• Subjects: Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000000474
• Languages: English
• ISSNs: 0749-5161

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objectives</title> <p>LowRisk Ankle Rule (LRAR) has 100% sensitivity for identifying clinically important pediatric ankle fractures (high-risk injuries) and has the potential to safely reduce imaging by approximately 60%. This study investigates the safety and cost-effectiveness of this rule in our institution.</p> </sec> <sec> <title>Methods</title> <p>All patients triaged during July and August 2013 with an "ankle injury" had a retrospective clinical notes and radiology report review. Data were recorded using Excel and tests of significance, χ<sup>2</sup> test.</p> </sec> <sec> <title>Results</title> <p>One hundred twenty-one patients were included. Of these, 65 were female and 56 were male (no significant difference in sex, <italic>P</italic> = 0.41). Mean age was 9.95 years. Seventy-eight (64%) had LRAR positive examinations. Of these, 77 (98.7%) had an x-ray and 12 (15%) had fractures. Of those with fractures, none had high-risk injuries.</p> <p>Eighteen (100%) of the doctors in our ED felt that a clinical decision rule would be of use within the department. Only 8 (44%) had heard of the LRAR, and of these, only 4 (50%) would be confident to implement the LRAR. Forty-four (88%) of parents felt that an x-ray is required in the diagnosis of ankle injuries in children, and 41 (82%) would want to know whether their child had an ankle sprain or a low-risk fracture even if the management was not different.</p> </sec> <sec> <title>Conclusions</title> <p>By implementing the LRAR in our institution, we could reduce ankle x-rays by 64%. This would offer a significant reduction in radiation exposure to a radiosensitive population. Estimated costs of an ankle x-ray and interpretation are [Euro sign]47 ($65), thus with more than 800 carried out per year in The Children's University Hospital, a potential annual saving is [Euro sign]25, 000 ($34, 500).</p> </sec> </abstract>