INTRODUCTION:
Ankle injuries account for 8% of all minor injuries attending emergency departments (ED) in the UK. Current practice aims to distinguish those that are simple sprains from those that are fractured. This is traditionally done by assessing the injury using percussion, compression and assessment of bony tenderness before sending those with bony tenderness for x-ray.
Nurse practitioners and doctors use the Ottawa Ankle Rules to identify those patients who require an x-ray of the ankle following an inversion or eversion injury1. Since the introduction of the Ottawa Ankle Rules ankle x-rays are said to have reduced by 35%2. Evidence shows that sending a patient to x-ray adds more than 30 minutes to their time in the ED3, impacting on the 4-hour national standard set by the Department of Health4.
WHY TUNING FORK?
A tuning fork has been used in conjunction with a stethoscope for identifying long bone fractures and fractures to the neck of femur in a number of studies5-7. A recent study tested the use of the tuning fork test in association with the Ottawa Ankle Rules on a select population following twisting ankle injury (Dissman and Han 2006), and identified that the number of ankle x-rays could be significantly reduced by employing this method.
STUDY OBJECTIVES:
The study objectives are...
- To assess whether we can improve the OARs when we use them with a tuning fork on Ottawa positive patients
- To see if staff and patients think the use of a tuning fork is acceptable.
- To see if the actual time spent in the emergency department(ED) waiting for an x-ray could have been reduced by seeing how much time patients could save if they were tuning fork negative and could be discharge home at that point.
WHO WILL BE INVITED TO TAKE PART?
If you are attending the Queen Alexandra Hospital in Portsmouth Emergency Department, the Gosport Minor injuries centre, the Winchester Hospital Emergency Department or the Emergency Department at Basingstokes North Hants Hospital,
because you have TWISTED your ankle, you will be invited to take part in this project only if you are assessed as having tenderness to one or more of the bones in your ankle and you need to have an x-ray.
You must be 12 years or older to take part! If you have injured your ankle through trauma (for example in a car accident or by jumping/falling from a height) or you did not injure your ankle by simply twisting it, then your injury is not eligible for inclusion in this study.
This will not affect your treatment in any way and you will be seen and treated exactly how you would normally be for this injury.
DO I HAVE TO TAKE PART?
No, it is up to you. The doctor or nurse who has assessed your injury will ask you to sign a form giving your consent to take part in the study, if you do not wish to take part then you do not have to sign the form. If you are 12 to 15 years old your parents or guardian will have to sign the form too. If you do sign, you will be given a copy of this information sheet and the signed consent form to keep. You are free to stop taking part in the project at any time without giving reason, just let the nurse or doctor know. Opting out in no way affects the care you will recieve for your injury.
Research and ethics committee approval ref : 09/h0502/57
REFERENCES:
- Steill et al. (1992). A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Annuls of Emergency Medicine, 21, 284-390 ↑
- Steill et al (1994). Implementation of the Ottawa Ankle Rules. JAMA 271(11), 827-32 ↑
- Bache & Cross. 91984). The Barford test: A useful diagnostic sign in fractures of the femoral neck. The Practitioner. March Vol 228, 305-308 ↑
- National Audit Office. (2004). Improving emergency care in England. London: Stationary Office ↑
- Peltier (1976). The diagnosis of fractures of the hip and femur by ausultatory percussion. Clinical Orthopaedics. 123, 9-11 ↑
- Lesho (1997). Can tuning forks replace bone scans for identification of tibial stress fractures. Military Medicine. 162(12), 802-803 ↑
- Fiessler et al. (2004). Can nurses appropriately interpret the Ottawa Ankle Rules. American Journal of Emergency Medicine. 22, 145-148 ↑