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Purpose. The Ottawa Ankle Rules (OAR) are extremely sensitive for detecting foot and ankle fractures, and are reportedly used by over 90% of Canadian emergency physicians. However, little is known about how this tool is used in practice. We surveyed physicians to determine whether they report using the OAR consistently and/or exclusively, and whether the rule can be remembered correctly.
Methods. We surveyed members of the Canadian Association of Emergency Physicians (CAEP) about their use of the OAR in practice, and tested their memory for the rule via a single multiple choice item in which they were asked to pick out the 5 components of the OAR from a series of 5 plausible alternatives. Conducted between March and May 2003, the 4-page survey included 24 largely closed-ended questions and 3 sections: one asking a series of questions about the OAR, another examining use of other clinical decision rules, and one on practice details and demographics. The sample frame included 400 active CAEP members, and excluded those listed as non-MD’s, retired, or not currently residing in Canada. The survey was conducted according to standard survey methodology (Dillman, 2000).
Results. Of our initial sample of 400 names, 376 were eligible potential respondents with correct addresses. Overall response rate was 261/376, or 69.4%. 260 / 261 respondents reported being familiar with the OAR. Of those, most reported applying the rule consistently; 90% reported using the OAR always or most of the time in rule-appropriate situations. The majority reported not using the rule exclusively; 42% reported basing their decision primarily on the basis of the rule, while 42% reported considering a small number of other factors, and 15% said that the OAR was only one of many factors going into their decision. Only 31% of respondents correctly recalled all components of the OAR and excluded all foils.
Conclusions. Almost all respondents reported being familiar with the OAR and most report using it consistently. Most report not using the rule exclusively, but consider other factors (some of which may be inappropriate) in a decision that might reasonably be governed by the rule alone. Memory for this simple rule was imperfect in the majority of respondents. How these considerations change the effectiveness of clinical decision rules warrants further study.
See more of Oral Concurrent Session B - Methods in Judgment and Decision Making
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)