Benefits, risks, and costs of alternative approaches to the evaluation and treatment of severe ankle sprain.

A cost-effectiveness analysis was used to compare five methods of management of severe ankle sprain: (1) wrapping the ankle immediately (i.e., without obtaining further roentgenograms); (2) casting the ankle immediately; (3) obtaining stress films and providing treatment accordingly by wrapping, casting, or surgery; (4) obtaining arthrograms and performing appropriate treatment; and (5) obtaining stress films, followed by arthrograms, in patients with positive stress films and administering appropriate treatment. The probability of ankle stability was high for all five strategies (greater than 97%). However, the expected days of morbidity from different strategies ranged from 36.2 to 73.4 per patient, the probability of premature death ranged from 1.5 to 17.7 per 100,000 patients, and the dollar costs ranged from $318 to $941 per patient. Cost-effectiveness and risk/benefit ratios indicated that the "wrap strategy" and the "stress film strategy" were clearly more cost-effective than the other three strategies.