Regras do Joelho de Pittsburgh Ir para: navegação, pesquisa

Purpose

A clinical decision rule used to indicate the use of radiography of the knee following an injury.

Criteria

Radiographs of the knee should performed if the mechanism of injury is a fall or blunt trauma and either one of the following:

1) Patient is younger than 12 or older than 50

2) Inability to walk four weight-bearing steps

These rules do not apply to individuals who present more than 6 days after injury, those with only superficial lacerations and abrasions, those with a previous history of knee injury or surgery on the affected knee, and those being reassessed for the same injury. ^[1]

Evidence

Diagnostic Accuracy

In a study by Seaberg et al., of 934 patients evaluated the Pittsburgh knee rules applied to 745 with a sensitivity of 0.99 and a specificity of 0.60.  There was the potential to reduce radiography by 52% with one missed fracture. ^[2]

In a more recent study by Cheung et al., the Pittsburgh knee rules had a pooled sensitivity of 0.86 and a pooled specificity of 0.51. ^[3]

Recommendations for Clinical Practice

The Pittsburgh knee rules are often compared to the Ottowa knee rules.  While the Pittsburgh knee rules have a higher specificity, each have almost identical sensitivities. ^[2][3] The ability of these rules to rule out a condition, and thus avoid a radiograph is important and their most valuable characteristics.  With proper training either set of rules could be adopted for use. ^[1]

References

1. ↑ ^1.01.1 Hawley C, Rosenblatt R. Ottowa and Pittsburgh rules for acute knee injuries. The Journal of Family Practice 1998;47(4):254-255. ↑ 2.0^2.1 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. Annals of Emergency Medicine 1998;32(1):8-13. ↑ 3.0^3.1 Cheung TC, Tank Y, Breederveld RS, Tuinebreijer WE, de Lange-de Klerk ES, Derksen RJ. Diagnostic accuracy and reproducibility of the Ottawa Knee Rule vs the Pittsburgh Decision Rule. American Journal of Emergency Medicine 2013;31(4):641-5. function gtElInit() { var lib = new google.translate.TranslateService(); lib.setCheckVisibility(false); lib.translatePage('en', 'pt', function (progress, done, error) { if (progress == 100 || done || error) { document.getElementById("gt-dt-spinner").style.display = "none"; } }); }