Pittsburgh Knee Rules
Decision rule for knee X-ray after acute knee injury. Complements the Ottawa Knee Rules. X-ray indicated if: age < 12 or > 50, OR mechanism (fall or blunt trauma) + one of the criteria.
Score interpretation
Pittsburgh Knee Rules: X-ray not indicated. Fracture very unlikely.
→ 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.
Pittsburgh Knee Rules: X-ray indicated. Age < 12 / > 50, or blunt trauma + unable to weight-bear.
→ 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.
- Seaberg DC et al. Multicenter comparison of two clinical decision rules for the use of radiography in acute, high-risk knee injuries. Ann Emerg Med. 1998.
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.