PMID: 15231460Jul 3, 2004Paper

Derivation of clinical prediction rules to identify children with fractures after twisting injuries of the ankle

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
Peter S DayanSteven Z Miller

Abstract

The authors sought to derive maximally sensitive prediction rules for identifying children with significant fractures after acute twisting injuries to the ankle. The authors prospectively enrolled a convenience sample of patients younger than 18 years of age who presented to the pediatric emergency department of an urban, tertiary care center after sustaining acute twisting injuries of the ankle. The ankle was defined in two regions: the malleolar zone and the midfoot zone. Clinical findings were documented on standardized data collection sheets by faculty physicians before completion of ankle and/or foot radiograph series. Significant fracture was defined a priori as any fracture other than an avulsion < or =3 mm. The authors conducted binary recursive partitioning with cross-validation to develop models to predict fracture. Data from 717 enrolled patients with a median age of 12.9 years were analyzed. Significant malleolar zone and midfoot zone fractures were diagnosed in 81 of 682 (11.9%) and 10 of 173 (5.8%) patients for whom ankle and foot radiographs were obtained. Recursive partitioning identified patients at low risk for malleolar zone fracture if 1) they had no bone tenderness at either malleolus or the region just pro...Continue Reading

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Citations

Apr 1, 2011·The American Journal of Emergency Medicine·Kimberly R SmithKori L Brewer
Aug 4, 2009·Annals of Emergency Medicine·Jocelyn GravelSerge Gouin
Oct 12, 2010·The American Journal of Emergency Medicine·Michael C BondWilliam Brady

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