Opinion: Children and the Ottawa ankle rules

September 1, 2008

Readers comment on the Ottawa ankle rules, radiologic imaging, and influenza immunization.

To the editor,

As a practicing pediatrician, I always enjoy your articles, especially the dermatology and sports articles. In the July 2008 article entitled "Running Injuries," author Katy Lilly, MD, states, "The Ottawa rules may help guide ordering imaging. Though these guidelines were originally designed for adult ankle injuries, several studies have validated the use of them in children." Two articles are listed as references, but one deals with hydration.

I've never heard that the Ottawa rules are applicable to children, and wanted you to verify that this is an accurate statement, since this was a major part of this article.

Dr. Lilly responds

Thank you for your interest in the article. I apologize for the error in the references regarding the Ottawa ankle rules. There have been several studies that have examined the validity of the rules in children. Archives of Disease in Childhood has an excellent review, and this is the proper reference to our article.1 The topic has been examined in several other studies. 2,3

One important caveat to using the rules in children is that the child must be able to verbally communicate and have the ability to walk prior to the injury. Please feel free to contact me if you have other questions.

Sincerely,Katy Lilly, MD

References

1. Myers A, Canty K, Nelson T: Are the Ottawa ankle rules helpful in ruling out the need to x ray examination in children? Arch Dis Child 2005;90;1309

2. Libetta C, Burke D, Brennan P, et al: Validation of the Ottawa Ankle Rules in Children. J Accident Emerg Med 1999;16:342

3. Plint AC, Bulloch B, Osmond MH, et al: Validation of the Ottawa Ankle Rules in children with ankle injuries. Acad Emerg Med 1999;6:1005