Users ’ Guides to the Medical Literature

CLINICAL SCENARIO You are the medical director of a busy inner-city emergency department. Faced with a limited budget and pressure to improve efficiency, you have conducted an audit of radiological procedures ordered for minor trauma and found a high rate of x-rays ordered for ankle and knee trauma. You are aware of the Ottawa ankle rules (FIGURE 1) that identify patients for whom ankle radiographs can be omitted without adverse consequences. In addition, you are aware that a small number of faculty and residents currently rely on these models to make quick frontline decisions in the emergency department. You are interested in knowing the accuracy of the rules, whether they are applicable to your patient population, and whether you should be implementing the rules in your own practice. Furthermore, you wonder if implementing the rules can change clinical behavior and reduce costs without compromising quality care. You decide to consult the original medical literature and to assess the evidence for yourself.