Face it: one of the most common experiences of being human is that painful “snap” when we over-turn an ankle. WebMD estimates the occurrence rate in the USA is approximately 25000 per day. It is sudden, unexpected, hurts really bad, and hinders our freedom of movement. It is no wonder that ankle x-rays rank with neck x-rays as the two most common radiological studies done in emergency departments all over the country.
It is estimated that 80% – 98% of persons presenting to an Emergency Department with mid-foot or ankle complaints receive x-rays for diagnostic purposes, but only 15% have any significant fracture. With the number of these ER visits exceeding 1 million per year, that means that there are slightly more than 750,000 ER visits with x-rays for something that needs no more treatment than an Ace wrap, a bag of frozen peas, a pillow to prop it up on, and $30 pair of crutches. (Chances are, in the life of a family, that $30 for the crutches will amortize over several ankle injuries and actually cost less-per-episode.)
Let’s do the math: Average the 80% – 98% = 89%. x 1 million = 890,000 ER visitors receiving a 3-view series of ankle x-rays. 890,000 x 0.85 = 756,500 series which show no fracture. (2 million, 269 thousand, 5 hundred x-rays– remember it’s a 3-view series.) 756,500 x $1500 (average ER visit cost for ankle exam, Ace wrap, Crutches) = $1,134,750,000
That’s radiation exposure from nearly 2.3 Million fruitless x-rays and the scalping of wallets to the tune of over $1.13 Billion dollars annually. In these days of high deductibles, that is mostly out-of-pocket whether insured or not.
Enter the Ottawa Ankle Rules. This specific set of examination criteria are highly specific ( that means they are useful in identification of the targeted problem) for ankle and mid-foot fractures, with nearly 100% sensitivity (that is, identifying existing fractures.) With this exam technique, you don’t miss fractures, and you eliminate nearly all of the x-rays that are negative for fracture. Only the ankles that test positive for fracture with the Ottawa Rules need to have an x-ray to get more specific about what is broken and how to fix it. The rest are successfully treated with RICE: Rest, Ice, Compression, Elevation. In the most remote possibility of a missed fracture, no harm exists in employing RICE for 5 days and x-ray later if no improvement.
Medical literature has been quite clear on the efficacy of the Ottawa Ankle Rules since the early 1990’s. ( http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/caserounds/05_06/apr06/ottawa2.pdf and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938320/ ). But public awareness seems nil.
Let’s look at the numbers again. With approximately 1 million ER visits per year, and an estimated 25000 sprains per day, that means that roughly 22,500 persons per day either seek care from a clinic or private physician, or simply take care of it themselves. It seems impossible to gather accurate statistics pertaining to these non-ER routes of treatment, but suffice it to say that they are successful. Were they not, we’d see a lot more people on crutches every day in every one of our towns.
If we could spread the word about the Ottawa Ankle Rules and RICE, we could reduce the costs of the common sprained ankle to about $40 including tax; yielding a savings to our wallets of $1,104,490,000 per year. Considering that NOTHING has been done to educate the public about this over the past 20 years, you do the math on the ankle money that has helped feed the hospital systems of America in the past 2 decades. Asking questions about WHY?…. I’ll leave that up to you.
LifeBidder Seminars are designed to put YOU in the management seat of your healthcare. They will include specific self-assessment and self-treatment options guaranteed to save you money. Take the time to attend a LifeBidder Seminar and avoid, among other things, being party to that $1.13 Billion-dollar wallet – lightening for America’s sprained ankles.
LifeBidder Seminars are scheduled to debut in April 2013 in the greater Tulsa region, and then branch out across the country. To schedule one in your area, send a message to bookings@LifeBidder.com