Pittsburgh Knee Rules: Difference between revisions
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'''Original Editor '''- [[User:Johnathan Fahrner|Johnathan Fahrner]] | '''Original Editor '''- [[User:Johnathan Fahrner|Johnathan Fahrner]] | ||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
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== Purpose | == Purpose == | ||
A clinical decision rule used to indicate the use of radiography of the knee following an injury. <br> | A clinical decision rule used to indicate the use of radiography of the knee following an injury. <br> | ||
{{#ev:youtube|TMw6SJP784U}} | |||
== Criteria | == Criteria == | ||
Radiographs of the knee should performed if the mechanism of injury is a fall or blunt trauma and either one of the following:<br> | Radiographs of the knee should performed if the mechanism of injury is a fall or blunt trauma and either one of the following:<br> | ||
# Patient is younger than 12 or older than 50 | |||
# Inability to walk four weight-bearing steps | |||
These rules do not apply to individuals who present more than 6 days after injury, those with only superficial lacerations and abrasions, those with a previous history of knee injury or surgery on the affected knee, and those being reassessed for the same injury. <ref name="Hawley">Hawley C, Rosenblatt R. Ottowa and Pittsburgh rules for acute knee injuries. The Journal of Family Practice 1998;47(4):254-255. http://www.ncbi.nlm.nih.gov/pubmed/9789509. (Accessed 25 Apr 2013).</ref> | These rules do not apply to individuals who present more than 6 days after injury, those with only superficial lacerations and abrasions, those with a previous history of knee injury or surgery on the affected knee, and those being reassessed for the same injury. <ref name="Hawley">Hawley C, Rosenblatt R. Ottowa and Pittsburgh rules for acute knee injuries. The Journal of Family Practice 1998;47(4):254-255. http://www.ncbi.nlm.nih.gov/pubmed/9789509. (Accessed 25 Apr 2013).</ref> | ||
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The Pittsburgh knee rules are often compared to the Ottowa knee rules. While the Pittsburgh knee rules have a higher specificity, each have almost identical sensitivities. <ref name="Seaberg" /><ref name="Cheung" /> The ability of these rules to rule out a condition, and thus avoid a radiograph is important and their most valuable characteristics. With proper training either set of rules could be adopted for use. <ref name="Hawley" /><br> | The Pittsburgh knee rules are often compared to the Ottowa knee rules. While the Pittsburgh knee rules have a higher specificity, each have almost identical sensitivities. <ref name="Seaberg" /><ref name="Cheung" /> The ability of these rules to rule out a condition, and thus avoid a radiograph is important and their most valuable characteristics. With proper training either set of rules could be adopted for use. <ref name="Hawley" /><br> | ||
== References == | |||
== References | |||
<references /> | <references /> | ||
[[Category:Musculoskeletal/Orthopaedics|Orthopaedics]][[Category:Knee]] | [[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] | ||
[[Category:Knee]] | |||
[[Category:Assessment]] | |||
[[Category:Knee - Assessment and Examination]] | |||
[[Category:Primary Contact]] | |||
[[Category:Clinical Prediction Rules]] | |||
Latest revision as of 11:04, 21 February 2022
Original Editor - Johnathan Fahrner
Top Contributors - Johnathan Fahrner, Admin, Kim Jackson, Kai A. Sigel, WikiSysop, Tony Lowe, Selena Horner, Claire Knott and Rochelle Dsouza
Purpose[edit | edit source]
A clinical decision rule used to indicate the use of radiography of the knee following an injury.
Criteria[edit | edit source]
Radiographs of the knee should performed if the mechanism of injury is a fall or blunt trauma and either one of the following:
- Patient is younger than 12 or older than 50
- Inability to walk four weight-bearing steps
These rules do not apply to individuals who present more than 6 days after injury, those with only superficial lacerations and abrasions, those with a previous history of knee injury or surgery on the affected knee, and those being reassessed for the same injury. [1]
Evidence[edit | edit source]
Diagnostic Accuracy[edit | edit source]
In a study by Seaberg et al., of 934 patients evaluated the Pittsburgh knee rules applied to 745 with a sensitivity of 0.99 and a specificity of 0.60. There was the potential to reduce radiography by 52% with one missed fracture. [2]
In a more recent study by Cheung et al., the Pittsburgh knee rules had a pooled sensitivity of 0.86 and a pooled specificity of 0.51. [3]
Recommendations for Clinical Practice[edit | edit source]
The Pittsburgh knee rules are often compared to the Ottowa knee rules. While the Pittsburgh knee rules have a higher specificity, each have almost identical sensitivities. [2][3] The ability of these rules to rule out a condition, and thus avoid a radiograph is important and their most valuable characteristics. With proper training either set of rules could be adopted for use. [1]
References[edit | edit source]
- ↑ 1.0 1.1 Hawley C, Rosenblatt R. Ottowa and Pittsburgh rules for acute knee injuries. The Journal of Family Practice 1998;47(4):254-255. http://www.ncbi.nlm.nih.gov/pubmed/9789509. (Accessed 25 Apr 2013).
- ↑ 2.0 2.1 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. http://www.ncbi.nlm.nih.gov/pubmed/9656942. (Accessed 25 Apr 2013).
- ↑ 3.0 3.1 Cheung TC, Tank Y, Breederveld RS, Tuinebreijer WE, de Lange-de Klerk ES, Derksen RJ. Diagnostic accuracy and reproducibility of the Ottawa Knee Rule vs the Pittsburgh Decision Rule. American Journal of Emergency Medicine 2013;31(4):641-5. http://www.ncbi.nlm.nih.gov/pubmed/23399332. (Accessed 25 Apr 2013).
