Pittsburgh Knee Rules

Why Use

Patients without criteria for imaging by the Pittsburgh decision rules are highly unlikely to have a fracture and do not need plain radiographs. It has a higher specificity than the Ottawa Knee Rule , reducing the number of false positives. Application of the Pittsburgh decision rules can cut down on the number of unnecessary radiographs by up to 78%.

When to Use

The Pittsburgh decision rules can be applied to all patients with an acute knee injury in the past 1 week old, without prior knee surgery or ED evaluation.

Formula

Pearls / Pitfalls

The Pittsburgh knee rules were derived to aid in the efficient use of radiography in acute knee injuries. Found in most studies to have a higher specificity than the Ottawa Knee Rule , which would mean fewer x-rays would be needed, while maintaining a sensitivity close to 100%. Not useful in children under age 12 as all these patients would require x-rays by the Pittsburgh decision rules. The Pittsburgh decision rules are not as well validated as the Ottawa Knee Rule with fewer external validation studies.

Management

For significant non-bony injuries, often crutches and a knee immobilizer can be helpful to assist with ambulation.

Critical Actions

Patients who do not meet the Pittsburgh decision rules do not need an x-ray. If one of the conditions are met, then x-ray is recommended.

Advice

Patients who do not meet the Pittsburgh decision rules do not need an x-ray. If one of the conditions are met, then x-ray is recommended.

More Information

Criteria Response Mechanism Blunt Trauma or Fall Y/N Age <12 Y/N Age >50 Y/N Unable to bear weight in ED? (4 steps, limping is allowed) Y/N