Authors
Danial Sharifi Razavi, Mohammadali Seiri, Mehrdad Farrokhi
Published in
Archives of academic emergency medicine. Volume 14. Issue 1. Pages e24. Epub Jun 18, 2026.
Abstract
The Ottawa Ankle Rules (OAR) have demonstrated conflicting results across studies, with generally high sensitivity but relatively low and variable specificity. This updated meta-analysis aims to evaluate the overall diagnostic characteristics of the OAR for early identification of ankle fractures in adult patients.
In this systematic review and meta-analysis, a comprehensive literature search was conducted from database inception through May 2026 across three electronic databases, including Medline, Web of Science, and Scopus. The MIDAS package in STATA and Meta-Disc software were used to pool the findings of the diagnostic accuracy studies. Clinical application of the OAR was assessed using Fagan's nomogram and scattergram.
The pooled sensitivity and specificity of OAR were 0.92 (95% confidence interval (CI): 0.91-0.93) and 0.35 (95% CI: 0.34-0.36), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 1.76 (95% CI: 1.46-2.13) and 0.13 (95% CI: 0.09-0.19), respectively. Furthermore, the pooled diagnostic odds ratio (DOR) was 16.21 (95% CI: 10.15-25.89).
In conclusion, the OAR demonstrate excellent sensitivity and a very low negative likelihood ratio, confirming their value as a reliable screening tool for ruling out ankle fractures in clinical practice. With pooled sensitivities exceeding 90% and a post-test probability reduced to approximately 1% following a negative result, the OAR can safely reduce unnecessary radiographic imaging.
PMID:
42524327
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.
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