| Pediatric emergency physician opinions on ankle radiograph clinical decision rules. | |
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MedLine Citation:
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PMID: 20653584 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The Low Risk Ankle Rule (LRAR) is a validated clinical decision rule (CDR) about the indications for ankle radiographs in children with acute blunt ankle trauma. Although application of the LRAR has the potential to safely reduce the rate of ankle radiography by 60%, current x-ray rates in most emergency departments (EDs) in the United States and Canada remain unnecessarily high (85%-100%). To evaluate this gap between knowledge and practice, physicians who treat pediatric ankle injuries in EDs were surveyed to determine physician awareness and use of the LRAR, acceptability of the LRAR as measured by the Ottawa Acceptability for Decision Rules Scale (OADRS), and perceived barriers to the use of a validated pediatric ankle x-ray rule. METHODS: An on-line survey of members of two national pediatric emergency medicine (PEM) physician associations in the United States and Canada was conducted using a modified Dillman technique. RESULTS: Response rates were 75.6% (149/197) in Canada and 45.7% (352/770) in the United States, yielding an aggregate rate of 51.8%. Only 119 of 478 respondents (24.9%) had heard of the LRAR, and 53 of 432 (12.3%) were sufficiently familiar with the LRAR to apply it. The LRAR scored a mean (+/- standard deviation [SD]) OADRS score of 4.28 out of 6 (+/-0.67), comparable to published OADRS scores for two well-known CDRs used in adults. Of the respondents, 434 of 471 (92.1%) at least "slightly agreed" that ankle x-ray CDRs would be useful in their practice, with no significant differences between the two sides of the border (p = 0.28). Ankle x-ray rules were felt to save time by 342 (72.6%) of the participants, and the pediatric ankle exam was considered easy enough to apply a CDR by 306 (65.0%). The most common barriers reported for use of any ankle x-ray rule included perceived reduction in family satisfaction without imaging in 380 (80.7%), nurse-initiated x-ray protocols not based on ankle x-ray rules in 285 (60.5%), concerns about missing a significant fracture in 248 (52.7%), and a preference for own clinical judgment in 246 (52.2%). CONCLUSIONS: Although the LRAR had a high acceptability score among respondents in this survey, this validated CDR is not widely known and is even less frequently applied by PEM physicians in the United States and Canada. Barriers were identified that will guide efforts to improve the knowledge translation of the LRAR into pediatric EDs. |
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Authors:
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Kathy Boutis; Erika Constantine; Suzanne Schuh; Martin Pecaric; Derek Stephens; Unni G Narayanan |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Volume: 17 ISSN: 1553-2712 ISO Abbreviation: Acad Emerg Med Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-26 Completed Date: 2010-12-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9418450 Medline TA: Acad Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 709-17 Citation Subset: IM |
Copyright Information:
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2010 by the Society for Academic Emergency Medicine |
Affiliation:
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Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada. boutis@pol.net |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Ankle Injuries
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radiography* Canada Child Decision Support Techniques* Emergency Medicine / methods* Humans Physician's Practice Patterns / statistics & numerical data* Questionnaires United States |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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