Using the “low-risk ankle rule” to assess children’s ankle injuries in emergency departments significantly reduces X-ray imaging, according to aCanadian Medical Association Journal study.

Nearly 2200 patients aged 3 to 16 years presented with acute ankle injuries to emergency departments designated as either intervention or control sites. Intervention sites applied the rule, which says that radiography may not be necessary when tenderness and swelling is isolated to the distal fibula and the adjacent lateral ligaments distal to the tibial anterior joint line. At control sites, procedures for ankle injuries were unchanged.

After implementation of the rule, intervention sites saw a 22-percentage-point reduction in weekly ankle radiography, compared with controls. Application of the ankle rule was not associated with an increase in significant fractures being missed or a decrease in physician or patient satisfaction.

The authors conclude: “Widespread implementation of this rule could safely lead to reduction of unnecessary radiography in this radiosensitive population and a more efficient use of healthcare resources.”

Source: CMAJ