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A cross-sectional survey of 74 urgent care and emergency physicians working in Riyadh, Saudi Arabia, found adherence to evidence-based ankle sprain guidelines was inconsistent despite high reported awareness of the guidelines, as published in Cureus. While 95.9% of physicians were familiar with the Ottawa Ankle Rules (OAR) that predict the need for radiographs for ankle injuries—and 70.3% reported using them—only 36.5% applied them consistently. Additionally, researchers found just 56.8% of physicians correctly identified the key diagnostic measures. When identifying criteria for ordering ankle radiographs based on OAR, only 42 physicians (56.8%) correctly selected tenderness at the posterior edge of the lateral malleolus as a key criterion, and only 24 physicians (32.4%) correctly identified tenderness at the posterior edge of the medial malleolus as a criterion. The authors say “this discrepancy suggests a notable gap between perceived familiarity and accurate clinical recall among the participants,” when applying OAR in practice. In terms of treatment, the familiar rest, ice, compression, and elevation protocol was the most common strategy recommended to patients, followed by ankle bracing or taping.
Decision rules: The OAR guidelines, which date back to the 1990s, are validated rules that predict the need for radiographs in acute ankle injuries to avoid unnecessary imaging for patients. In the survey, respondents said lack of time or training were the main barriers to adherence to OAR guidelines.