Overview
Ankle sprain in children is a very common pathology. Currently in France, a standard X-ray is done in almost all cases. However, the literature has for several years validated the consideration of the Ottawa ankle rules in children to avoid the realization of these X-rays.
Our study is an evaluation of clinical practice. The aim is to assess the impact of the implementation of a new protocol using the Ottawa ankle rules from the age of 5. In particular, radiographic sparing and absence of diagnostic error.
Description
Main objective: To compare the rate of X-rays performed before and after implementation of the protocol in pediatric emergencies.
Secondary objectives (if applicable):
- Compare the time spent in the emergency room of patients before and after implementation of the protocol
- Evaluate the gain in terms of cost for the healthcare system
- Evaluate the adherence of caregivers to compliance with the protocol
- Evaluate the decrease in the rate of X-rays performed in different age groups.
- Evaluation of the consultation rate in the month for the same reason
Primary endpoint = X-ray rate as a % of X-rays performed on the number of children presenting to pediatric emergencies over the period studied (before implementation of the protocol in a similar period = May to October 2022 / after implementation of the protocol = May to October 2023) Secondary endpoints =
- Time spent in the emergency room in min
- Estimation of the cost for the healthcare system by taking the cost of an x-ray and evaluating the gain on the reduction in the rate of x-rays performed (number of x-rays - cost of an x-ray)
- Evaluation of caregiver compliance by measuring the number of X-rays performed outside the protocol (X-ray performed despite the absence of Ottawa criteria)
- X-ray rate by age group
- Spontaneous reconsultation rate within 1 month
Eligibility
Inclusion Criteria:
- 5 to 18 years old
- consulting in pediatric emergency in Nancy children hospital
- for ankle injury
Exclusion Criteria:
Constitutional bone disease Polytrauma Inability to assess the patient (inebriated, altered
consciousness, neurosensitive disease, intoxication) Non-acquired walking Injury more than
10 days old Patient re-consults for the same injury previously assessed in the same centre
Patient with previous radiographs prior to consultation Open fracture Sensory or vascular
deficit Haemophilia Metabolic disease with proven osteopenia