Decision rules and physician judgment

Decision-making rules such as Ottawa ankle rules have been widely adopted because of their potential for safely reducing a patient’s exposure to costly and unnecessary testing such as x-rays.

Afina Glas and colleagues asked surgical residents in Amsterdam to perform a history and physical examination of 690 consecutive patients with ankle injuries and complete a standard data collection form that incorporated elements of both the Ottawa and Leiden ankle rules. The physicians reported whether they felt a radiograph was necessary, and all patients underwent ankle radiography.

The authors found that the sensitivity and specificity of the physician’s judgment was 89% and 26% respectively for the Ottawa rules, 80% and 59% for the Leiden rule and 82% and 38% for the physicians’ judgement. Eight fractures (including 1 clinically significant fracture) were missed with the Ottawa rules, 15 fractures (5 clinically significant) were missed with the Leiden rule, and the residents missed 13 fractures (1 clinically significant). The authors conclude that, with the aid of structured data collection, physician’s judgement was similar to existing ankle rules in terms of sensitivity and ability to safely reduce the number of radiographic examinations.

p. 727 Comparison of diagnostic decision rules and structured data collection in assessment of acute ankle injury
— A.S. Glas et al

---

---