Use of Ottawa Ankle Decision Rules to Evaluate Blunt Ankle Trauma Case Studies by United States Air Force Health Care Providers

Practice guidelines are developed through a formal process incorporating the best scientific evidence of effectiveness with expert opinions. Clinical guidelines like the Ottawa Ankle Rules OAR may serve an increasingly important role within the evolving role of nurse practitioners NPs and physician assistants PAs within the United States Air Force USAF health care model called TRICARE. The OAR have been found to be specific and valid decision rules concerning the common problem of blunt ankle trauma BAT. Few x-rays for this condition are positive for clinically significant fractures. Use of the OAR by USAF NPs and PAs is unknown. The purpose of this descriptive study was to determine if a sample of NPs and PAs are aware of the OAR. Secondly, what clinical information, tests or rules are used by respondents to correctly determine whether or not to x-ray is warranted in written case BAT scenarios. This study asks if there is a theoretical cost benefit in OAR use Descriptive data were gathered using case scenarios to measure diagnostic accuracy. Data from 29 respondents indicate lack of awareness of the OAR. There was a 1 difference in accuracy between the 18 NPs and 11 PAs in 11 scenarios. A formula applied to the cases of inaccurately ordered x-rays demonstrated a theoretical cost benefit of 1,300 to 3,900. Use of the OAR after a brief education process may improve patient satisfaction, decrease waiting times, and demonstrate cost savings with no increase in rate of missed fractures, or increased provider liability. Use of the OAR may facilitate efficient evaluation of BAT in field conditions.