Minimising negative ankle and foot X-rays in the Emergency Department -- are the Ottawa ankle rules good enough?

Objectives: To review fracture rates in patients who had X-rays of either the ankle or foot or both in the Emergency Department of a district hospital.

Method: A retrospective review of 2589 Emergency Department patients who had X-rays of the ankle or foot or both over a 12-month period.

Results: There were 1199 ankle X-rays taken of which 193 (16%) showed a significant fracture.

Using computerised patient-alert system.

SThe information technology systems used in most modern emergency departments alert staff to patients who require special management, including those with infections or histories of violence, or children on the child protection register. These systems can improve care for patients, protect staff and prevent infection, although their benefits must be weighed against the risks involved in storing sensitive data on computers. It is essential, therefore, that such systems are professionally maintained and updated.

Transporting major trauma patients from the margins of a UK trauma system.

Objective: For serious motor vehicle crashes (MVC) occurring in a rural area to quantify: how many occur more than 45 min by road to a major trauma centre (MTC); how many occur more than 45 min by helicopter to an MTC; and how many patients might have to be taken to a local trauma unit if their incident occurs more than 45 min by road from an MTC and when the helicopter cannot fly.

Methods: MVC occurring in Shropshire, in which patients were killed or seriously injured during 2006-9 (inclusive) were analysed using the following parameters: distance from MTC by road; distance from MTC by air; weather and visibility-related factors that affect the operation of a helicopter emergency medical service.

Results: 722 serious MVC occurred, of which 626 (87%) occurred more than 45 min by road from the MTC.