Journal Club Summary

Methodology Score: 3/5       
Usefulness Score: 2/5
Boutis K, et al. CMAJ. 2013 Oct 15;185(15):E731-8
This multicenter implementation study of a pediatric Low Risk Ankle Rule demonstrated an initial and sustained 20% decrease in radiography rate. Although the rule maintained 100% sensitivity for clinically significant injuries, our local practice is to refer Salter Harris II injuries for orthopedic follow-up, which this rule would classify as a low-risk injury not requiring an x-ray. Additionally, JC attendees felt that the Ottawa Ankle Rule has undergone multiple external validations in pediatric populations, and feel more comfortable with its use.  
By: Dr. Omer Yusuf
(Presented October 2014)

Epi lesson: Stages of Clinical Decision Rule Development

Clinical Decision Rules require 4 key stages of development prior to adoption in to clinical practice: derivation, prospective validation, evaluation of implementation and knowledge translation. Be very cautious incorporating any decision rule into your practice which has not been through these key steps. Examples of such rigorous decision rules include the Canadian CT head rule, Canadian C-spine rule and Ottawa Ankle rule.  
By: Dr. Lisa Calder