Ottawa Ankle Rules: A Reliable Clinical Instrument to Detect Fractures in Children and Adolescents.

 To evaluate the accuracy of the Ottawa Ankle Rules (OARs) applied to the medical records of a high-complexity hospital and a private clinic and to analyze their clinical utility in subjects aged 16 or younger.  The present is a cross-sectional, analytical observational study with secondary data collected from an orthopedic emergency department and a private orthopedic clinic. The sample consisted of 144 subjects, including all patients with ankle torsion episodes who underwent ankle and/or foot radiographs upon admission. We adopted the OARs as the diagnostic test to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios using the radiographic examination finding as the gold standard.  A total of 191 patients were selected, 144 of whom were included after the application of the inclusion criteria. The sensitivity and NPV of the OARs for fracture identification were of 100%, with the most sensitive test and highest NPV being the inability to walk four steps. We identified a potential reduction of 43.8% in the total number of radiographs requested if only patients with positive OARs underwent the examination.  The OARs seem to be a reliable clinical tool in ankle sprain management and a useful clinical protocol to exclude fractures in pediatric patients. Their use demonstrated their ability to reduce unnecessary radiograph requests, minimizing radiation exposure and healthcare system costs.