Table 6
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Chande VT, 1995, USA68 patients aged 2–18 yearsProspective. DiagnosticAnkle fracturesSensitivity 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, Canada318 adults and children (37 children) presenting with ankle injury to a community EDValidation CohortSensitivity of rules in age <16100% sensitivityVery small number of children in larger study
potential reduction in radiographs if rules had been applied22%Not all patients received radiographic gold standard
Plint AC et al, 1999, Canada670 patients aged 2–16 yearsProspective. DiagnosticAnkle and midfoot fracturesFor 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, UK761 patients aged 1–15 yearsProspective. DiagnosticAnkle and midfoot fracturesSensitivity 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.