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Patients arriving at hospital emergency departments with acute ankle sprains can expect more timely advice and follow-up care in future after researchers in Oxford developed a new tool that will aid clinical decisions on treatment.

Hands holding a foot with the ankle coloured red to show a sprain

Ankle sprains are very common and represent up to 5% of all A&E admissions in the UK; between 20% and 30% of those patients are still struggling with pain and mobility issues nine months later.

The researchers at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) at the University of Oxford, supported by the NIHR Oxford Biomedical Research Centre and the NIHR's Health Technology Assessment programme, aimed to develop a prognostic model for identifying those people at a higher risk of poor outcome after an acute ankle sprain.

Their study on the SPRAINED (Synthesising a clinical Prognostic Rule for Ankle Injuries in the Emergency Department) prognostic model was published in the open access BMJ Open journal on Tuesday 6 November.

Dr David Keene of NDORMS, who was part of the team who led the study, said: "Many patients arrive at A&E in a lot of pain, making these injuries very difficult to assess. Currently, the majority of patients are not referred for follow-up visits to monitor progress or physiotherapy, as clinicians cannot predict who will recover and who would potentially benefit from further care.

"The new SPRAINED tool will provide clinicians with a risk score, supporting their decision-making process when providing advice to people with ankle sprains, and when deciding on ongoing management."

The tool was developed by a team of researchers, clinical practitioners and statisticians, based on data from a previous clinical trial on ankle sprains. SPRAINED was then tested on 682 patients at 10 emergency departments in the UK.

Whilst there are limitations, the research showed that the SPRAINED tool, which uses predictors that are simple to obtain during routine clinical assessment, gave a valuable insight on who could be at higher risk of a poor outcome, namely pain, lack of confidence and ongoing difficulties with the injured ankle.

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