Nurse practitioners and the Ottawa Ankle Rules: comparisons with medical staff in requesting X-rays for ankle injured patients

Abstract

This paper reports on part of a study of 354 consecutive attendances to an Accident and Emergency (A&E) department by patients with ankle injuries. The aim of this study was to examine the percentage of X-ray photographs requested by nurse practitioners compared to those requested by medical practitioners. The study took place in an A&E department where nurse practitioners have the authority to request X-rays photographs for ankle injuries, either at triage assessment or at the subsequent treatment stage. Nurse practitioners applied the Ottawa Ankle Rules (OAR) in 187 patients. The results show that nurse practitioners requested X-rays for 61.5% of patients assessed using the OAR. This is compared with 80.4% for patients assessed by medical practitioners. The difference is highly significant. Detection rates show that fractures were identified in 29.6% of patients sent for X-ray by nurse practitioners compared with 22.8% in patients seen by medical practitioners, although this difference is not significant. Although nurse practitioners applied the OAR appropriately in all 187 cases, four patients who were assessed by nurse practitioners and judged not to need an X-ray photograph were subsequently found to have a fracture.