Purpose: The Pittsburgh Knee Rules were developed in order to determine the need for radiographs after acute knee injury secondary to the risk of fracture.

Stage of CPR Development: Validated.

Rule:

Blunt trauma or a fall as mechanism of injury PLUS either of the following:
1. Age older than 50 years or Younger than 12 years
2. Inability to walk 4 weight-bearing steps in the emergency department

Interpretation:

Study Sensitivity Specificity NPV
Seaburg et al., 1994 1.00 0.79 100%
Bauer et al., 1995 1.00 N/A 100%
Seaburg et al., 1998 0.99 0.60 N/A
Simon et al., 2005 0.77 0.57-0.58 N/A
Cheung et al., 2013 0.86 0.51 98%

Research:

1. Seaberg DC, et al. Clinical decision rule for knee radiographs. Am J Emerg Med. 1994; 12(5): 541-3.

2. Bauer SJ, et al. A clinical decision rule in the evaluation of acute knee injuries. J Emerg Med. 1995; 13(5): 611-5.

3. Seaberg DC, et al. Multicenter comparison of two clinical decision rules for the use of radiography in acute, high-risk knee injuries. J Emerg Med. 1995; 13(5): 611-5.

4. Simon LV, et al. The Pittsburgh Decision Rule: triage nurse versus physician utilization in the emergency department. The Journal of emergency medicine. 2006; 31(3): 247-250. doi:10.1016/j.jemermed.2005.12.020.

5. Cheung TC, et al. Diagnostic accuracy and reproducibility of the Ottawa Knee Rule vs the Pittsburgh Decision Rule. Am J Emerg Med. 2013; 31(4): 641-5.

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