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QUESTION: In emergency departments patients with an acute ankle sprain, are the Ottawa ankle rules accurate for excluding fractures of the ankle and midfoot?
Studies were identified by searching 6 databases, reviewing reference lists, and contacting authors.
Studies published in any language were selected if they evaluated the Ottawa ankle rules for diagnosing fractures of the ankle or midfoot and reported sufficient data to calculate the false positive and false negative rates.
Data were extracted on sample size, demographic characteristics of the patients, setting, type of Ottawa ankle rules used, study quality, and outcomes. Main outcomes included sensitivity, specificity, and negative likelihood ratios. After inspection of the receiver operating characteristics curve, sensitivities but not specificities were pooled using the …