Table 6
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study weaknesses |
|---|---|---|---|---|---|
| Chande VT, 1995, USA | 68 patients aged 2–18 years | Prospective. Diagnostic | Ankle fractures | Sensitivity 100% (95% CI. 77% to 100%). Specificity 32% (95% CI. 21% to 43%) | Small sample size Only 54% of patients were aged 12 or below Inter-rater reliability was not assessed |
| McBride KL, 1997, Canada | 318 adults and children (37 children) presenting with ankle injury to a community ED | Validation Cohort | Sensitivity of rules in age <16 | 100% sensitivity | Very small number of children in larger study |
| potential reduction in radiographs if rules had been applied | 22% | Not all patients received radiographic gold standard | |||
| Plint AC et al, 1999, Canada | 670 patients aged 2–16 years | Prospective. Diagnostic | Ankle and midfoot fractures | For ankle fractures - Sensitivity 100% (95% CI. 95% to 100%). Specificity 24% (95% CI. 20% to 28%). For midfoot fractures - Sensitivity 100% (95% CI. 82% to 100%). Specificity 36% (95% CI. 29% to 43%) | Not every patient was radiographed. 305 eligible patients were not included Only 25% of patients were aged 9.7 or below Inter-rater reliability was not assessed |
| Libetta C et al, 1999, UK | 761 patients aged 1–15 years | Prospective. Diagnostic | Ankle and midfoot fractures | Sensitivity 98.3% (95% CI not given). Specificity 46.9% (95% CI not given). (Combined analysis for ankle and foot fractures) | Only 10.6% of patients were aged 5 or below Not every patient was radiographed Inter-rater reliability was not assessed. |
