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Ottawa Ankle Rules Compliance in Emergency Department X-ray Requests

Guy's and St Thomas' NHS Foundation Trust Orthopaedics & Trauma 2022 25 Apr 2026 56 views

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Background

Why this project was needed

The Ottawa Ankle Rules are a validated clinical decision tool used to determine the need for radiography following ankle injury, and have been shown to reduce unnecessary X-ray requests without missing significant fractures. Despite their wide adoption nationally, compliance in busy Emergency Departments can be variable. A review of ankle and midfoot X-ray requesting behaviour at GSTT was undertaken to assess adherence to this evidence-based guideline.

Aims

What the project set out to achieve

To assess the degree of compliance with the Ottawa Ankle Rules when requesting ankle and foot X-rays in the Emergency Department at GSTT.

Objectives

Specific measurable steps

  1. Identify a consecutive cohort of patients who received ankle or midfoot X-rays following acute injury.
  2. Assess whether documented clinical findings met Ottawa Ankle Rule criteria for imaging.
  3. Calculate the proportion of requests consistent with guideline recommendations.
  4. Present findings to the Emergency Department and orthopaedic team to inform future practice.

Discussion

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