Pittsburgh knee rules pdf

You suspect a soft tissue injury and are aware that the ottawa knee rule could be used to help determine whether radiography is necessary. A clinical decision rule used to indicate the use of radiography of the knee following an injury. Unable to bear weight both immediately and in the emergency room department for 4 steps. While care is taken to ensure the information provided is accurate, errors may be present. The pittsburgh knee rules define when knee xrays are unnecessary after minor trauma.

Predictive variables include a fall or blunt trauma as the mechanism of injury, inability. Use only for injuries rules have been developed for the evaluation of knee injuries,, of which the pittsburgh decision rule pdr and the ottawa knee rule okr are the best known guidelines with the largest validation cohorts for the selective use of radiographs in knee trauma. The pittsburgh knee rules are medical rules created to ascertain whether a knee injury requires the use of xray to assess a fracture. The accuracy of the ottawa knee rule to rule out knee fractures. The decision rules assessed different clinical parameters that increase the likelihood of. A patient with knee pain qualifies for a radiograph if.

It is not clear whether this rule can be applied to children. Pittsburgh knee rules definition of pittsburgh knee. Pittsburgh knee rules definition of pittsburgh knee rules. Predictive variables include a fall or blunt trauma as the mechanism of injury, inability to ambulate initially or in the er i. The aim of this present study was to compare the diagnostic accuracy and reproducibility of 2 clinical decision rules the ottawa knee rules okr and pittsburgh decision rules pdr developed for selective use of xrays in the evaluation of isolated knee trauma.

Information on this website is intended for educational purposes only. The ottawa and pittsburgh rules for the selective use of radiographic assessment in acute knee injuries were devised initially to reduce the number of unnecessary knee radiographs. Age older than 50 years or younger than 12 years 2. Pre and post pittsburgh decision rules implementation. The rules have been demonstrated to decrease unnecessary diagnostic imaging and emergency room wait times which enhances patient comfort and reduces health care costs. Defines when knee xrays are unnecessary, based on the pittsburgh rules. The pittsburgh knee rules were developed in 1995 and are presented below. Nov 01, 2018 the ottawa knee rule is a validated tool 98. Ottawa knee rule ottawa hospital research institute. At your side is a team of doctors from these disciplines, who proactively work together to resolve your unique health problems and conditions. To establish whether the okr had adequate sensitivity and acceptable specificity in children to advocate widespread use. A clinical prediction rule used to determine whether an individual requires plain xrays to rule out a knee fracture after an acute or blunt injury. Five patients 5% had a fracture of their knee and in all cases, the ottawa and pittsburgh knee rules were fulfilled.

Jul 21, 2018 the pittsburgh knee rules pkrs and similar decisionmaking rules were developed to improve accuracy in the use of xray imaging in cases of acute knee injuries. They state that an xray is required only in patients who have an acute knee injury with one or more of the following. University of manchester, manchester, uk a 30yearold man presents to the emergency department ed after twisting his knee. Additionally, it has been demonstrated that the use of pkrs reduces. Use the ottawa knee rules in people over 2 years of age to determine. Pdf the accuracy of the ottawa knee rule to rule out knee. The pittsburgh knee rule is a sensitive and specific decision rule for identifying patients who have signs and symptoms associated with fracture. Can the ottawa and pittsburgh rules reduce requests for radiography in patients referred to acute knee clinics. Pittsburgh knee rules ottawa knee rules order knee xrays for acute knee injuries if any of the 5 items are present originally reported by steil ig, et al, 1996 jama blunt trauma or fall imaging no imaging age younger than 12. However, because the rule is calibrated toward 100% sensitivity and actual fracture prevalences are usually low, largescale, multicentered studies are still needed to establish the costeffectiveness of routinely implementing the rule. If the patient satisfies the above criteria, they should receive an xray to assess for. Clinical prediction rules are not intended to replace clinical decision making of licensed healthcare practitioners and should not be used as such. Unfortunately, knee pain affects a significant portion of the adult population.

The pittsburgh knee rules help in triaging patients with traumatic knee pain and evidence has shown that it could help in reducing the number of referrals for unnecessary radiographs. The amsterdam wrist rules are validated clinical decision rules for determining which patients require radiographic imaging wrist radiography for acute wrist pain following trauma. Jan 20, 2004 a negative result on an ottawa knee rule test accurately excluded knee fractures after acute knee injury. Diagnostic clinical prediction rules clinical prediction. Knee pain is a common presenting complaint in the emergency department ed and accounts for approximately 1. The initial study evaluated 882 patients and were published in 2015 1. 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. The pittsburgh knee rules state that knee radiographs are.

Possible causes include osteoarthritis of the knee, injuries such as muscle strain and fractures, tumours, referred pain from the hip or lumbosacral spine, and bursitis. Ottawa knee rules for obtaining radiographs in acute knee injury can be used to determine if the patient should get an xray or not. Evaluating acutely injured patients for internal derangement. The accuracy of the ottawa knee rule to rule out knee.

Aug 12, 2016 the pittsburgh decision rule is a clinical prediction rule that assists in the decision making whether an xray is needed in the case of knee injury using a standardized protocol to exlude a fracture. The pittsburgh knee rules are medical rules created to ascertain whether a knee injury requires. The ottawa rules are a set of clinical decision rules developed by dr. The pittsburgh knee rules were developed in order to determine the need for radiographs after acute knee injury secondary to the risk of fracture. Inability to walk four weightbearing steps in the emergency department. Ankle rules for ankle injury radiography a an ankle xray series is only required if there is any pain in malleolar zone and any of these findings. Openurl1crossref2pubmed3web of science4 q in patients with acute knee injuries, is the ottawa knee rule okr accurate for ruling out knee fractures. Other potential knee related problems include trauma or sports injuries. Knee pain is a common condition, particularly in older people. Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa. In summary the rules suggest that if a patient has suffered a fall or blunt trauma to their knee and they are aged below 12 years old or over 50 years old or they have suffered a fall or blunt trauma to their knee and cannot walk 4 steps in the ed then they should have an xray.

The pittsburgh knee rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for knee pain a patient with knee pain qualifies for a radiograph if. Thus, while the ottawa knee rule has been more extensively. The following table summarizes the rules one can use to determine if an xray should be ordered for a patient with acute knee. The pittsburgh knee rules are often compared to the ottowa knee rules. Pittsburgh knee pain relief center is a unique medical clinic that combines the best of medical and rehabilitation treatments. Plain radiographs of the knee are among the most commonly ordered radiographs in u. Blunt trauma or a fall as mechanism of injury plus either of the following. While the pittsburgh knee rules have a higher specificity, each have almost identical sensitivities. Pittsburgh knee pain center effective knee pain treatment. Principles of orthopaedic and trauma care pittsburgh knee rules.

This screening tool was developed because of the need for a rapid and accurate way to avoid unnecessary imaging. Pkrs have a sensitivity close to 100% 8,9,10,11,12, and an interobserver agreement of 0. Adequacy of clinical information with reference to the. The ottawa knee rule okr, a clinical decision aid is used to reduce unnecessary radiography. Diagnostic accuracy and reproducibility of the ottawa knee. Pdf the ottawa knee rule is a clinical decision aid that helps rule out fractures. The ottawa knee rules are a set of rules used to help physicians determine whether an xray of the knee is needed.

Using the ottawa rules, 27 radiographs 25% could have been avoided without. Member clubs of the league may amend the rules from time to time, pursuant to the applicable voting procedures of the nfl constitution and bylaws. Pittsburgh knee pain relief center delivers safe and effective treatments for knee related pain. The ottawa knee rules are useful in ruling out fracture high sensitivity when negative, but poor for ruling in fractures many false positives. Can the ottawa and pittsburgh rules reduce requests for. The effectiveness of these rules have been well validated in numerous studies conducted in the us 3,6,7,8 but there are limited data on their application in the uk. This edition of the official playing rules of the national football league contains all current rules governing the playing of professional football that are in effect for the 2011 nfl season. The pittsburgh knee rules pkrs and similar decisionmaking rules were developed to improve accuracy in the use of xray imaging in cases of acute knee injuries. Pittsburgh knee rules can be also used to determine if the patient needs a knee xray. As you grow older, the knee joint and cartilage can deteriorate, resulting in osteoarthritis. Tenderness of patella is significant only if an isolated finding.

It is a useful tool for use in the emergency department to help clinicians decide if a patient requires an xray. Unable to transfer weight twice onto each lower limb regardless of limping. It is also well proven to have a better specificity compared to the ottawa knee rules 1. Description of the ottawa knee rule for use of radiography in acute knee injuries.