Clinical Decision Rule of Seaberg and Jackson for Radiography in Acute Knee Injuries (Pittsburgh Knee Rule)

 

Patient selection:

• Only patients with injury within 7 days of presentation.

• Patients excluded if they had isolated skin injuries, were pregnant, had a history of previous surgery on the knee, or were returning for reassessment of the same knee injury.

 

Decision rule: A knee radiograph is performed if:

(1) the mechanism of injury is either blunt trauma or fall, AND

(2) one of the following:

(2a) age < 12 years

(2b) age > 50 years

(2c) inability to walk 4 weight-bearing steps in the Emergency Department

 

Performance when both elements of rule are used:

• In the initial evaluation the sensitivity was 100% and specificity 79%.

• The initial evaluation indicated that it could reduce X-ray studies by 79%.

• In a comparison with the Ottawa knee rule (Seaberg 1998) the sensitivity was 99% and the specificity was 60%.