Chronic Diseases in Canada

Volume 31, no. 2, March 2011

Referral of acute ankle injuries for radiography in Kingston, Ontario: an evaluation of physician adherence to the Ottawa Ankle Rules

Dowdall H. (1); Nichol M. (1); Brison R. (1,2); Pickett W. (1,2)

Background/Purpose/Objectives: The Ottawa Ankle Rules were established in 1992 as evidence-based clinical decision rules for the ordering of radiography in emergency department settings. We evaluated adherence to these rules over time in two hospital-based emergency departments in Kingston, using a record linkage study.

Study design/Methods: In this population-based, retrospective study, we linked records of ankle injuries from Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program (2001–2007) to hospital discharge records containing procedural codes. Proportions of ankle injuries referred for radiography were described temporally, and compared with the referral rate in 1993 following implementation of the Ottawa Ankle Rules.

Results: Compared with a baseline referral rate of 57.6% (95% CI: 55.3–59.9) following implementation of the Ottawa Ankle Rules, analysis of 7706 acute ankle injuries shows that the proportion of ankle injuries referred for radiography has increased (e.g. 70.3 % [95% CI: 67.3–72.9] in 2007). The proportion of referrals with a diagnosis of fracture remains the same throughout the study period (18.3% to 21.9%).

Conclusions: Physicians need to adhere to the Ottawa Ankle Rules in order to reduce costs within the emergency department and to limit patient exposure to radiographic procedures.

The relationship between adiposity and Gleason score in men with localized prostate cancer

Hack E.E. (3); Siemens D.R. (4); Groome P.A. (3)

Background/Purpose/Objectives: The association between adiposity and the aggressiveness of prostate cancer (PCa) is controversial. We investigated the relationship between body mass index (BMI) at the time of PCa diagnosis and malignant phenotype as measured by Gleason score.

Study design/Methods: In this cross-sectional study conducted on 1096 PCa patients treated for cure in Ontario, data from an electronic dataset were enhanced by retrospective chart review. BMI was categorized as normal (BMI < 25.0 kg/m²), overweight (BMI: 25.0–29.9 kg/m²) and obese (BMI ≥ 30 kg/m²). We also investigated the role of diabetic status. We categorized Gleason scores into clinically meaningful categories, 2–4, 5–6, 7 and 8–10.

Results: BMI was not associated with Gleason score; 9.7% of those with normal BMI have Gleason scores greater than or equal to 8, and 9.4% in this Gleason score category are overweight or obese (p = .73). Of those with diabetes, 11.7% have Gleason scores greater than or equal to 8 compared to 9.3% in the non-diabetic group (p = .79). When stratified by age, the Gleason score distribution in the youngest obese cohort trended toward higher Gleason scores (p = .13).

Conclusions: Neither elevated BMI nor diabetic status at the time of diagnosis appears to be associated with Gleason score. The effect of adiposity on PCa requires further study with attention to length of exposure to an elevated BMI.

 

Author References

1. Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada
2. Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
3. Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston, Ontario, Canada
4. Department of Urology, Queen’s University, Kingston, Ontario, Canada