Prospective and retrospective diagnostic cohort studies that assessed the accuracy of Ottawa Ankle Rule for diagnosis of fractures of the ankle or midfoot in children (18 years or less) who presented to the emergency department with an acute blunt ankle and/or midfoot injury were eligible for inclusion. Studies had to include X-ray of the ankle and/or foot or a proxy measure as the reference standard and report sufficient data to construct a 2x2 table of test performance. Children had to be able to walk to be included. Studies that included both adults and children were eligible if data were reported separately for children.
Included studies were prospective or retrospective and assessed the ankle, foot or both. Mean/median age ranged from 11 to 13 years, where reported (overall range one to 18 years). Studies were conducted in Canada, USA, UK, France and Mexico.
Two reviewers independently assessed studies for inclusion. Disagreements were resolved through discussion or referral to a third reviewer.