Pittsburgh Knee Rules
Decision rule for knee radiography after acute knee injury (Seaberg 1994). X-ray indicated if the mechanism is blunt trauma or a fall AND either age < 12 or > 50 years OR inability to walk four weight-bearing steps in the ED. A twisting injury alone does not meet the rule. Complements the Ottawa Knee Rules.
Score interpretation
Pittsburgh Knee Rules not met — fracture very unlikely (sensitivity 99 % in the multicentre validation, Seaberg 1998).
→ No knee X-ray required. RICE: rest, ice, compression, elevation. Analgesia (paracetamol/NSAIDs). Crutches if needed. Physiotherapy if ligamentous injury suspected. Review if no improvement in 2–4 weeks.
Fall or blunt trauma with age < 12 / > 50 years or inability to walk 4 weight-bearing steps.
→ Knee X-ray (AP + lateral, ± skyline view). If fracture identified: orthopaedic review. If X-ray negative but significant effusion: consider haemarthrosis → joint aspiration. MRI if ligamentous/meniscal injury suspected.
Interpretation bands for the Pittsburgh Knee. Apply clinical judgement and local guidance.
References
- Seaberg DC, Jackson R. Clinical decision rule for knee radiographs. Am J Emerg Med. 1994;12(5):541–543.
- 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. Ann Emerg Med. 1998;32(1):8–13.
Related
Curated clinical cross-links plus same-class fallbacks.
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Enoxaparin · Low Molecular Weight Heparin (LMWH)
- Tinzaparin sodium · Low molecular weight heparin
- Enoxaparin sodium · Low molecular weight heparin (LMWH)
- Dalteparin sodium · Low molecular weight heparin (LMWH)
- Bemiparin sodium · Low molecular weight heparin (LMWH)
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.