Ottawa ankle rules: Sign may not be objective

doi:10.1136/bmj.326.7399.1147-a

BMJ 2003;326:1147 (24 May), doi:10.1136/bmj.326.7399.1147-a

Letter

Ottawa ankle rules

Sign may not be objective

The first 100% of the full text of this article appears below.

EDITOR—In their paper on the accuracy of the Ottawa ankle rules Bachmann et al consider the wide variation in specificity,citing subtlety of palpation technique as a possible contributing factor.¹

They are correct. If you palpate an ankle, or anything elsefor that matter, and ask the patient, "Is that sore?" you willinvariably get a much higher positive response rate than ifyou palpate silently and simply observe for a non-verbal response.

The moment you rely on a patient to "give you" your clinical sign you are no longer dealing with an objective sign, suchas an enlarged liver or a heart murmur. Instead you are dealingwith an extension of symptoms, with all the subjectivity thatthis entails. It is no wonder then that studies that rely onthe estimation of bony tenderness are frequently associatedwith wide variations in specificity.

Adrian Fogarty, consultant in accident and emergency medicine

Royal Free Hospital, London NW3 2PF afogarty@btinternet.com

Competing interests: None declared.

Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003;326: 417. (22 February.)[Abstract/Free Full Text]

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Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review: Lucas M Bachmann, Esther Kolb, Michael T Koller, Johann Steurer, and Gerben ter Riet
BMJ 2003 326: 417. [Abstract] [Full Text] [PDF]