A systematic review 1 abstracted in DARE included thirty-two studies assessing the Ottawa ankle rules, of which 16 assessed the ankle, 11 the mid-foot and 10 a combination of the two. Twenty-seven studies (n=15,581) were available for pooling, of which 12 assessed the ankle, 8 the mid-foot, 10 a combination of the two, and 6 assessed the ankle or mid-foot in children.
Overall, the pooled sensitivity of the Ottawa rules was 97.6% (95% CI: 96.4, 98.9) and the median specificity was 31.5% (IQR: 23.8, 44.4). The pooled sensitivity was 98% (95% CI: 96.3, 99.3) for the ankle, 99% (95% CI: 97.3, 100) for the foot and 96.4% (95% CI: 93.8, 98.6) for the two combined. The median specificity was 39.8% (IQR: 27.9, 47.7) for the ankle, 37.8% (IQR: 24.7, 70.1) for the foot and 26.3% (IQR: 19.4, 34.3) for the two combined.
Overall, the probability of having a fracture after a negative result was 1.73% (95% CI: 1.05, 2.75). The probability of having a fracture after a negative result was 1.39% (95% CI: 0.53, 3.08) for the ankle, 1.39% (95% CI: 0.53, 3.41) for the foot and 2.91% (95% CI: 1.73, 5.03) for the two combined. The results for further subgroups were also reported.
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