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The Pittsburgh Knee rule was derived by Seaberg et al. 1994 as a sensitive clinical decision rule to help clinicians determine when an x-ray is required for patients presenting with acute knee pain. The rule has been externally validated to provide a 99% sensitivity and 60% for the detection of knee fractures in patients with knee pain in the setting of blunt trauma or fall injuries.
This rule is one of two commonly used clinical tools for acute knee pain, the other being the Ottawa Knee rule. These have been compared head to head since their derivation including in the initial external validation for the Pittsburgh rule. That study (Seaberg et al. 1998) found that the Pittsburgh Knee rule had a greater sensitivity and specificity (99% and 60%) compared to the Ottawa Knee rule (97% and 27%). One advantage to the Pittsburgh rule is that unlike the Ottawa rule, it can be applied to patients less than 18 years old.
Variable & Associated Points
Mechanism blunt trauma or fall
Age < 12
Age > 50
Inability to walk 4 weight bearing steps in the ED
If "Yes" to the mechanism criteria:
If "No" to the mechanism criteria:
References
Seaberg DC and Jackson R.
Clinical decision rule for knee radiography.
American Journal of Emergency Medicine.1994;12(5):541-3.
Seaberg DC, Yealy DM, Lukens T, Auble T, Mathias S.
Multicenter comparison of two clinical decision rules for the use of radiography in acute, high-risk knee injuries
Annals of Emergency Medicine. 1998;32(1):8-13.
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