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. It is a useful tool for use in the emergency department to help clinicians decide if a patient requires an xray. Information on this website is intended for educational purposes only. 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. The pittsburgh knee rules state that knee radiographs are. Feb 01, 2012 the presence of effusion is a predictor of internal derangement. As you grow older, the knee joint and cartilage can deteriorate, resulting in osteoarthritis. Pkrs have a sensitivity close to 100% 8andan interobserver agreement of 0. Predictive variables include a fall or blunt trauma as the mechanism of injury, inability to ambulate initially or in the er i. 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. 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.
Description of the ottawa knee rule for use of radiography in 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. Additionally, it has been demonstrated that the use of pkrs reduces. The ottawa knee rule okr, a clinical decision aid is used to reduce unnecessary radiography. Plain radiographs of the knee are among the most commonly ordered radiographs in u. Knee pain is a common presenting complaint in the emergency department ed and accounts for approximately 1. Unfortunately, knee pain affects a significant portion of the adult population.
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. Ottawa knee rules for obtaining radiographs in acute knee injury can be used to determine if the patient should get an xray or not. Diagnostic clinical prediction rules clinical prediction. The pittsburgh knee rules are often compared to the ottowa knee rules. The initial study evaluated 882 patients and were published in 2015 1. Jan 20, 2004 a negative result on an ottawa knee rule test accurately excluded knee fractures after acute knee injury. Pittsburgh knee pain center effective knee pain treatment. Pittsburgh knee rules definition of pittsburgh knee. You suspect a soft tissue injury and are aware that the ottawa knee rule could be used to help determine whether radiography is necessary.
The amsterdam wrist rules are validated clinical decision rules for determining which patients require radiographic imaging wrist radiography for acute wrist pain following trauma. The ottawa knee rules are a set of rules used to help physicians determine whether an xray of the knee is needed. 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. Knee rule for knee injury radiography a knee xray series is only required for knee injury patients with any of these findings. 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. The rules have been demonstrated to decrease unnecessary diagnostic imaging and emergency room wait times which enhances patient comfort and reduces health care costs. 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. 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.
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 ottawa knee rules are useful in ruling out fracture high sensitivity when negative, but poor for ruling in fractures many false positives. It is not clear whether this rule can be applied to children. Pkrs have a sensitivity close to 100% 8,9,10,11,12, and an interobserver agreement of 0. 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. Age older than 50 years or younger than 12 years 2. Five patients 5% had a fracture of their knee and in all cases, the ottawa and pittsburgh knee rules were fulfilled. A clinical decision rule used to indicate the use of radiography of the knee following an injury. Predictive variables include a fall or blunt trauma as the mechanism of injury, inability. The pittsburgh knee rule is a sensitive and specific decision rule for identifying patients who have signs and symptoms associated with fracture. The accuracy of the ottawa knee rule to rule out knee.
Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa. Unable to transfer weight twice onto each lower limb regardless of limping. 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. The pittsburgh knee rules were developed in order to determine the need for radiographs after acute knee injury secondary to the risk of fracture. While the pittsburgh knee rules have a higher specificity, each have almost identical sensitivities. Pittsburgh knee rules definition of pittsburgh knee rules. At your side is a team of doctors from these disciplines, who proactively work together to resolve your unique health problems and conditions. Principles of orthopaedic and trauma care pittsburgh knee rules. The accuracy of the ottawa knee rule to rule out knee fractures. The pittsburgh knee rules were developed in 1995 and are presented below. The ottawa knee rules determine the need for radiographs in acute knee injuries.
The pittsburgh knee rules were derived to aid in the efficient use of radiography in acute knee injuries. Clinical prediction rules are not intended to replace clinical decision making of licensed healthcare practitioners and should not be used as such. Defines when knee xrays are unnecessary, based on the pittsburgh rules. 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. The ottawa rules are a set of clinical decision rules developed by dr. The decision rules assessed different clinical parameters that increase the likelihood of.
Tenderness of patella is significant only if an isolated finding. Blunt trauma or a fall as mechanism of injury plus either of the following. A patient with knee pain qualifies for a radiograph if. 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 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 define when knee xrays are unnecessary after minor trauma. If the patient satisfies the above criteria, they should receive an xray to assess for. Knee pain is a common condition, particularly in older people. Pre and post pittsburgh decision rules implementation.
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. Using the ottawa rules, 27 radiographs 25% could have been avoided without. Pdf the ottawa knee rule is a clinical decision aid that helps rule out fractures. Thus, while the ottawa knee rule has been more extensively. Inability to walk four weightbearing steps in the emergency department. The pittsburgh knee rules are medical rules created to ascertain whether a knee injury requires the use of xray to assess a fracture. To establish whether the okr had adequate sensitivity and acceptable specificity in children to advocate widespread use. 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. While care is taken to ensure the information provided is accurate, errors may be present.
Openurl1crossref2pubmed3web of science4 q in patients with acute knee injuries, is the ottawa knee rule okr accurate for ruling out knee fractures. This screening tool was developed because of the need for a rapid and accurate way to avoid unnecessary imaging. Pdf the accuracy of the ottawa knee rule to rule out knee. It is also well proven to have a better specificity compared to the ottawa knee rules 1. Adequacy of clinical information with reference to the. University of manchester, manchester, uk a 30yearold man presents to the emergency department ed after twisting his knee. Use the ottawa knee rules in people over 2 years of age to determine. A colleague suggests that you should use the pittsburgh. Nov 01, 2018 the ottawa knee rule is a validated tool 98.
Ottawa knee rule ottawa hospital research institute. The pittsburgh knee rules are medical rules created to ascertain whether a knee injury requires. Can the ottawa and pittsburgh rules reduce requests for radiography in patients referred to acute knee clinics. Can the ottawa and pittsburgh rules reduce requests for. Pittsburgh knee pain relief center delivers safe and effective treatments for knee related pain. Evaluating acutely injured patients for internal derangement. 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.
Pittsburgh knee rules can be also used to determine if the patient needs a knee xray. 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. Other potential knee related problems include trauma or sports injuries. Diagnostic accuracy and reproducibility of the ottawa knee. Pittsburgh knee pain relief center is a unique medical clinic that combines the best of medical and rehabilitation treatments. The pittsburgh knee rules are a clinical decisionmaking strategy for determining which patients require radiographic imaging for knee pain.