Pittsburgh Knee Rule
Info
Blunt trauma or fall as mechanism of injury? Yes No
Age <12 or >50 years Yes No
Unable to weight bear in the emergency department for 4 steps (4 steps = Able to transfer weight twice onto each lower limb regardless of limping) Yes No
R e s u l t s
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Pittsburgh Knee Rule

The Pittsburgh Knee Rule was developed to decrease unnecessary use of knee radiography for trauma in the Emergency Department.

This rule appears to perform better than the Ottawa Knee Rule.

Both the Ottawa and Pittsburgh X-ray rules appear to decrease utilization of knee radiography, and improve waiting times, without an increase in missed fractures.

The required item must be selected, and an additional major criterion must be selected for Xray to be indicated.

Required item:

  • Blunt trauma or fall as mechanism of injury?

Major Criteria:

  • Age <12 or >50 years
  • Unable to weight bear in the emergency department for 4 steps (4 steps = Able to transfer weight twice onto each lower limb regardless of limping)

Clinical note:

  • Fractures occur in only 6% of knee trauma
  • The Ottawa Knee Rules have 97% sensitivity and 27% specificity and reduce knee X-rays by 28%
  • The Pittsburgh Knee Rules have 99% sensitivity, 60% specificity and reduce knee X-rays by 52%

References:

  • Bauer SJ, Hollander JE, Fuchs SH, et al. A clinical decision rule in the evaluation of acute knee injuries. J Emerg Med. 1995;13(5):611-5.
  • Bulloch B, Neto G, Plint A, et al. Validation of the Ottawa Knee Rule in children: a multicenter study. Ann Emerg Med. 2003;42(1):48-55.
  • Seaberg DC, Yealy DM, Lukens T, et al. Multicenter comparison of two clinical decision rules for the use of radiography in acute, high-risk knee injuries. Ann Emerg Med. 1998;32(1):8-13.
  • Tandeter HB, Shvartzman P. Acute knee injuries: use of decision rules for selective radiograph ordering. Am Fam Physician. 1999;60(9):2599-608.