Reglas del tobillo de Ottawa: análisis de su validez como reglas de decisión clínica en la indicación de radiografías en los traumatismos de tobillo y/o medio pie
The Ottawa ankle guidelines: analysis of their validity as clinical decision guidelines in the indications of x-rays for ankle and/or middle-foot traumas
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Ámbito. Urgencias hospitalarias.</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adultos que acudieron a urgencias por TTM desde el 1 de junio de 1999 al 31 de marzo de 2000. Fueron criterios de exclusión: edad menor de 18 años, embarazadas, graves alteraciones sensoriales y/o de la conciencia, politraumatizados y/o policontusionados, traumatismos de más de una semana de evolución, lesiones cutáneas secundarias al traumatismo, realización de radiografía en otro ámbito, gran inflamación o edema que impidiera la palpación de los relieves óseos.</p> <span class="elsevierStyleSectionTitle">Mediciones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Aplicación de las RTO y realización de radiografía a todos los pacientes, con independencia del resultado de aquéllas. Cálculo de sensibilidad, valor predictivo negativo, especificidad y valor predictivo positivo.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Sobre una muestra de 494 pacientes, 56 presentaron fractura (11,34%), 34 de la zona maleolar (6,9%) y 22 de la zona del medio pie (4,44%). La sensibilidad de las RTO fue del 96,43% (IC del 95%, 94,8-98%). El valor predictivo negativo fue del 97,22% (IC del 95%, 95,77-98,67%). La especificidad fue del 15,98% (IC del 95%, 12,75-19,21%) y el valor predictivo positivo, del 12,8% (IC del 95%, 9,86-15,74%).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las RTO son válidas en nuestro medio como reglas de decisión a la hora de solicitar radiografías en los pacientes con TTM.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To analyse the validity of the Ottawa ankle guidelines (OAG) as clinical decision guidelines in the indications of X-rays for ankle and/or middle-foot traumas in primary care.</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Observational, with application of the OAG and prospective measurement of the results.</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Hospital casualty.</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Adults who attended casualty for ankle or middle-foot traumas between 1st June 1999 and 31th March 2000. Criteria for exclusion were: under 18, pregnancy, grave sensory and/or awareness disturbances, multi-trauma or multi-contusion patients, traumas over a week old, skin lesions as side-effects of the trauma, X-ray in other department, high inflammation or oedema hindering palpation of bone protuberances.</p> <span class="elsevierStyleSectionTitle">Measurements</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Application of the OAG and X-ray on all patients, regardless of the result of the OAG. Calculation of sensitivity, negative predictive value, specificity and positive predictive value.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">56 of a sample of 494 patients had a fracture (11.34%), 34 in the malleolus area (6.9%) and 22 in the middle-foot area (4.44%). OAG sensitivity was 96.43% (95% CI, 94.8-98). Negative predictive value was 97.22% (95.77-98.67). Specificity was 15.98% (12.75-19.21), and positive predictive value was 12.8% (9.86-15.74).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The OAG are valid in primary care as guidelines to decide whether to request X-rays for patients with ankle or middle-foot traumas.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The frequency of injury, and epidemiology of ankle sprains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. 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| año/Mes | Html | Total | |
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| 2021 Noviembre | 94 | 30 | 124 |
| 2021 Octubre | 48 | 20 | 68 |
| 2021 Septiembre | 30 | 17 | 47 |
| 2021 Agosto | 21 | 11 | 32 |
| 2021 Julio | 29 | 12 | 41 |
| 2021 Junio | 18 | 13 | 31 |
| 2021 Mayo | 35 | 20 | 55 |
| 2021 Abril | 42 | 36 | 78 |
| 2021 Marzo | 39 | 49 | 88 |
| 2021 Febrero | 41 | 47 | 88 |
| 2021 Enero | 31 | 33 | 64 |
| 2020 Diciembre | 22 | 48 | 70 |
| 2020 Noviembre | 27 | 35 | 62 |
| 2020 Octubre | 36 | 20 | 56 |
| 2020 Septiembre | 47 | 29 | 76 |
| 2020 Agosto | 37 | 23 | 60 |
| 2020 Julio | 25 | 22 | 47 |
| 2020 Junio | 15 | 11 | 26 |
| 2020 Mayo | 23 | 23 | 46 |
| 2020 Abril | 24 | 18 | 42 |
| 2020 Marzo | 32 | 31 | 63 |
| 2020 Febrero | 40 | 32 | 72 |
| 2020 Enero | 36 | 47 | 83 |
| 2019 Diciembre | 56 | 94 | 150 |
| 2019 Noviembre | 22 | 36 | 58 |
| 2019 Octubre | 24 | 25 | 49 |
| 2019 Septiembre | 33 | 48 | 81 |
| 2019 Agosto | 43 | 42 | 85 |
| 2019 Julio | 61 | 118 | 179 |
| 2019 Junio | 102 | 193 | 295 |
| 2019 Mayo | 241 | 391 | 632 |
| 2019 Abril | 89 | 207 | 296 |
| 2019 Marzo | 50 | 82 | 132 |
| 2019 Febrero | 52 | 142 | 194 |
| 2019 Enero | 41 | 91 | 132 |
| 2018 Diciembre | 34 | 76 | 110 |
| 2018 Noviembre | 35 | 75 | 110 |
| 2018 Octubre | 59 | 29 | 88 |
| 2018 Septiembre | 73 | 70 | 143 |
| 2018 Agosto | 170 | 189 | 359 |
| 2018 Julio | 215 | 123 | 338 |
| 2018 Junio | 192 | 94 | 286 |
| 2018 Mayo | 210 | 139 | 349 |
| 2018 Abril | 190 | 112 | 302 |
| 2018 Marzo | 240 | 65 | 305 |
| 2018 Febrero | 241 | 60 | 301 |
| 2018 Enero | 246 | 42 | 288 |
| 2017 Diciembre | 146 | 42 | 188 |
| 2017 Noviembre | 190 | 49 | 239 |
| 2017 Octubre | 268 | 29 | 297 |
| 2017 Septiembre | 226 | 19 | 245 |
| 2017 Agosto | 307 | 10 | 317 |
| 2017 Julio | 337 | 39 | 376 |
| 2017 Junio | 221 | 47 | 268 |
| 2017 Mayo | 74 | 29 | 103 |
| 2017 Abril | 59 | 16 | 75 |
| 2017 Marzo | 78 | 66 | 144 |
| 2017 Febrero | 343 | 24 | 367 |
| 2017 Enero | 214 | 24 | 238 |
| 2016 Diciembre | 295 | 18 | 313 |
| 2016 Noviembre | 461 | 21 | 482 |
| 2016 Octubre | 593 | 52 | 645 |
| 2016 Septiembre | 195 | 52 | 247 |
| 2016 Agosto | 17 | 7 | 24 |
| 2016 Julio | 267 | 14 | 281 |
| 2016 Junio | 599 | 46 | 645 |
| 2016 Mayo | 467 | 48 | 515 |
| 2016 Abril | 402 | 23 | 425 |
| 2016 Marzo | 410 | 26 | 436 |
| 2016 Febrero | 509 | 35 | 544 |
| 2016 Enero | 415 | 34 | 449 |
| 2015 Diciembre | 285 | 30 | 315 |
| 2015 Noviembre | 549 | 35 | 584 |
| 2015 Octubre | 621 | 44 | 665 |
| 2015 Septiembre | 471 | 39 | 510 |
| 2015 Agosto | 333 | 19 | 352 |
| 2015 Julio | 478 | 40 | 518 |
| 2015 Junio | 320 | 19 | 339 |
| 2015 Mayo | 266 | 27 | 293 |
| 2015 Abril | 251 | 30 | 281 |
| 2015 Marzo | 247 | 14 | 261 |
| 2015 Febrero | 197 | 4 | 201 |
| 2015 Enero | 105 | 7 | 112 |
| 2014 Diciembre | 120 | 6 | 126 |
| 2014 Noviembre | 114 | 5 | 119 |
| 2014 Octubre | 138 | 6 | 144 |
| 2014 Septiembre | 118 | 6 | 124 |
| 2014 Agosto | 110 | 3 | 113 |
| 2014 Julio | 121 | 3 | 124 |
| 2014 Junio | 98 | 6 | 104 |
| 2014 Mayo | 85 | 4 | 89 |
| 2014 Abril | 87 | 2 | 89 |
| 2014 Marzo | 93 | 4 | 97 |
| 2014 Febrero | 92 | 1 | 93 |
| 2014 Enero | 67 | 3 | 70 |
| 2013 Diciembre | 59 | 4 | 63 |
| 2013 Noviembre | 87 | 8 | 95 |
| 2013 Octubre | 108 | 6 | 114 |
| 2013 Septiembre | 44 | 5 | 49 |
| 2013 Agosto | 72 | 15 | 87 |
| 2013 Julio | 43 | 4 | 47 |
| 2001 Junio | 2173 | 0 | 2173 |
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