Journal Reviews

Karpas A, Hennes H, Walsh-Kelly CM. Utilization of the Ottawa Ankle Rules by nurses in a pediatric emergency department. Acad Emerg Med 2002; 9:130-133.

ED nurses can accurately use and interpret the Ottawa Ankle Rules, which are used to assess whether radiographic evaluation is needed for patients with acute ankle injuries. This can reduce the number of radiographs ordered for children with these injuries, says this study from the Medical College of Wisconsin in Milwaukee.

The hospital ED uses a protocol in which radiographs are ordered for all patients with ankle pain, swelling, deformity, or decreased range of motion prior to physician evaluation. In this study, 190 children with ankle injuries were assessed by the ED nurse, and the Ottawa Ankle Rules were applied to determine whether a radiograph was needed. The study found that the Ottawa Ankle Rules were interpreted correctly by the nurse 98.4% of the time, and their use would have reduced the number of negative radiographs by 21%. The researchers report that the majority of nurses found the Ottawa Ankle Rules easy to use and interpret. (To see sample discharge instructions for Ankle Fracture in Children, click here.)

Only one child with negative Ottawa Ankle Rules results was found to actually have a fracture, but it was a Salter-Harris type 1 fracture that is typically identified clinically, not radiographically, note the researchers. "Had the [Ottawa Ankle Rules] been part of the nursing protocol, this would have been the only subject with a fracture who did not have a radiograph requested prior to physician assessment," they wrote.

Gray-Eurom E, Seaberg DC, Wears RL. The prosecution of sexual assault cases: Correlation with forensic evidence. Ann Emerg Med 2002; 39:39-46.

When caring for victims of sexual assault, EDs are obligated to provide not only medical treatment, but also a forensic examination for a possible legal defense, say researchers from the University of Florida Health Science Center in Jacksonville. The study’s findings are based on 355 forensic examinations performed by the same nine examiners, using a standardized approach, each with an identified suspect and a known legal conclusion.

During the forensic examinations, trauma was evident in 202 (57%) of the cases, and spermatozoa were found in 110 (31%) of the cases. The presence of trauma strongly correlated with successful prosecution, and increased use of DNA analysis will increase the importance of spermatozoa detection for a successful prosecution, say the researchers. They recommend the following:

  • Use of ready-made kits to facilitate evidence collection and paperwork.
  • Use of the hospital laboratory to assist with spermatozoa detection if the examiner does not feel confident doing this.
  • Careful documentation of weapon use and the use of force that can be testified to in court.

The researchers argue that the arrest and prosecution of the assailant is an important step in the recovery process for a rape victim. "It is essential for all health care providers performing forensic examinations to take accurate histories and to document detailed trauma findings for all victims of sexual assault," they conclude. "The information gathered by a thorough forensic examination does make a difference in the legal outcome for cases of sexual assault."