Diagnostic accuracy of Ottawa rules in diagnosing ankle fractures among patients taking X ray as gold standard.

Abstract

Objective: To determine the diagnostic accuracy of the Ottawa Ankle Rules (OAR) in diagnosing ankle fractures among patients, with X-ray imaging as the gold standard. Study Design: Cross-sectional study. Setting: Emergency Department of Lady Reading Hospital, Peshawar. Period: 1^st January 2024 to 30^th June 2024. Methods: 286 cases patients aged 18 to 60 years, presenting with ankle twisting and pain within 6 hours, were included. Exclusion criteria included patients unable to answer the Ottawa questionnaire or those refusing X-ray imaging. Following informed consent, patients were assessed using the Ottawa Ankle Rules and underwent X-ray imaging. The results were classified into true positives, false positives, true negatives, and false negatives. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: The mean age of participants was 36.73±6.7 years, with 67.13% males and 32.86% females. Ankle fractures were more common on the right side (62.93%). Among normal radiographs, 55.24% were correctly classified, while 18.18% were false positives. In patients with radiographic fractures, 23.77% were correctly identified. The sensitivity of the Ottawa Rules was 95.18%, while specificity was 56.67%. The positive predictive value was 68.72%, and the negative predictive value was 92.16%. Sensitivity was high in both males (92.73%) and females (94.55%), though specificity was lower in males (42.86%) compared to females (56.10%). Conclusion: The Ottawa Ankle Rules demonstrated high sensitivity for detecting ankle fractures but lower specificity.