Clinical Trial: Implementation of the Low Risk Ankle Rule
Study Status: Completed
Recruit Status: Completed
Study Type: Interventional
Official Title: Controlled Radiography for Ankle Injury Cases in Kids in the Emergency Department: Implementation of the Low Risk Ankle Rule
Brief Summary:
Ankle injuries are a very common injury in children. Each year approximately 35000 kids present to Ontario emergency departments (ED) with this problem. Right now, about 90% of these children get x-rays of the injured ankle, even though only 12% of these x-rays show a break in the bone. Some excellent research has created some rules that doctors can use to help them decide which children really need x-rays. Unfortunately, even though these rules have been proven to safely reduce x-rays by as much as two-thirds, most doctors are not using these rules.
Therefore, this study will be the first to put the best paediatric ankle x-ray rule, the Low Rick Ankle Rule, into physician practice in EDs. Our main goal is to determine how much we can reduce ankle x-ray rates in EDs that use this rule regularly versus those that do not. If we show that doctors can safely use this rule regularly and the number of ankle x-rays will be significantly less, this will lessen unnecessary potentially harmful radiation exposure in children, these children will spend less time in an ED, and the health care system will save money.
Detailed Summary:
Sponsor: The Hospital for Sick Children
Current Primary Outcome: To assess the impact of a LRAR implementation strategy on paediatric ankle radiography rates in participating EDS. [ Time Frame: three six month phases of implementation ]
Original Primary Outcome: Same as current
Current Secondary Outcome:
- Ankle x-ray rate changes at individual hospital from pre-LRAR to post-LRAR implementation phases. [ Time Frame: duration of subjects participation in study ]
- Intervention and control sites will be compared individually and collectively, during the post-LRAR for: missed significant fractures, number of unscheduled x-rays following initial ED visit, total length of stay, patient and physician satisfaction [ Time Frame: duration of subjects participation in study ]
- To determine the sustainability of the clinical impact of the LRAR strategy at intervention sites by comparing high and low intensity implementation phases with respect to weekly x-ray rates, missed fractures and physician and patient satisfaction [ Time Frame: duration of subjects participation in study ]
- To evaluate the performance of the LRAR during the implementation period of the rule at intervention sites with respect to: sensitivity and specificity of the LRAR for detecting "high risk" fractures and physician compliance with use of the rule [ Time Frame: duration of subjects participation in study ]
- To compare total costs of "low risk injuries" at intervention versus control sites during the post-LRAR implementation phase. [ Time Frame: duration of subjects participation in study ]
Original Secondary Outcome: Same as current
Information By: The Hospital for Sick Children
Dates:
Date Received: November 4, 2008
Date Started: November 2008
Date Completion:
Last Updated: May 12, 2014
Last Verified: May 2014
