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BET 1: Predicting the need for knee radiography in the emergency department: Ottawa or Pittsburgh rule?

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Report by: Bryony Patrick

Search checked by: Richard Body

Institution: University of Manchester, Manchester, UK

Clinical scenario

A 30-year-old man presents to the emergency department (ED) after twisting his 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. A colleague suggests that you should use the Pittsburgh rule instead. You wonder which rule has greater sensitivity (thus missing fewer fractures) and greater specificity (thus reducing the need for unnecessary radiography).

Three-part question

In (adult patients presenting to the emergency department with traumatic knee pain) does the (Ottawa knee rule or the Pittsburgh knee rule) have (greater sensitivity and specificity for knee fractures)?

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