2 - International Conference in Emergency Medicine and Public Health-Qatar Proceedings
  • ISSN: 1999-7086
  • EISSN: 1999-7094


In the past 3 years, average length of stay in the emergency department has increased by 20–30%. It was found that one of the most important factor causing this was increased number of X-rays done. At an average one x-ray adds 4–5 hours to disposition time. An observational study was done to find out reasons for the low compliance with usage of Ottawa ankle rules.

Initially observational study was done where 100 physicians were observed while they examine ankle and foot sprain cases for requesting x-ray. This was done without their knowledge. Then a questionnaire was distributed among 100 Emergency doctors to determine the factors that lead to non-compliance with use of Ottawa rules as screening tool for requesting x-ray.

In the initial observational study done on 100 cases we found that, only 20 patients presenting with symptoms of ankle /foot injury had bony injury ruled out by Ottawa rules and in 11 out of these, Ottawa rule was not done appropriately. The questionnaire was completed by 100 physicians. The result showed that 64% of physicians were afraid of the liability of missing fracture. 56% were not comfortable because of difficulty in follow up. 24% expressed that increased number of patients with limited time to assess patient thoroughly put a pressure to do X-ray. 48% were not aware of Ottawa rules. 32% mentioned that lack of emergency follow-up clinics for those with persistent symptoms compel them to request x-rays than to decide clinically.

A proper follow-up system for patients discharged after screening will reduce the fear of liability of missing fractures. This will reduce the number of x-rays and length of stay in ED.


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  • Article Type: Research Article
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