title: X-rays for Acute Knee Injuries: Pre- and Post- Pittsburgh Decision Rules Implementation. A District General Hospital Experience.
abstract: BACKGROUND
  We wanted to assess the number of unnecessary radiographs done for acute knee injury patients and the accuracy of the Pittsburgh decision rules.
  
  
  METHODS
  A retrospective observational study was done to look at the acute knee injury patients presented to a district general hospital Accident and Emergency Department from August 2011 till August 2013. We assessed the following parameters: sex, age, mechanism of injury, weight-bearing status and incidence of fractures in patients subjected to plain radiograph. A prospective study was then done from April 2014- August 2014 following implementation of the Pittsburgh decision rules.
  
  
  RESULTS
  24% of the patients had knee X-ray, compared to 72.12% in the first cycle. 36.8% had fracture, compared to 6.1% first cycle, with 66.7 % reduction in x-rays. Pittsburgh decision rules sensitivity was 100% and specificity 85.3%, positive predictive value 45.8% and accuracy 87%.
  
  
  CONCLUSIONS
  1. The Pittsburgh decision rules is highly sensitive, specific and accurate in determining the need of X-ray in acute knee Injuries. 2. We found that the Pittsburgh decision rules performs well in our hospital, which coincides with previously published literature.
authors.affiliation: Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom.
authors.forename: Saad R
authors.initials: SR
authors.lastname: El Ashry
authors.affiliation: Dumfries & Galloway Royal Infirmary, United Kingdom.
authors.forename: Tarek A
authors.initials: TA
authors.lastname: El Gamal
authors.affiliation: Dumfries & Galloway Royal Infirmary, United Kingdom.
authors.forename: Sudhakar R
authors.initials: SR
authors.lastname: Challagundla
authors.affiliation: Dumfries & Galloway Royal Infirmary, United Kingdom.
authors.forename: Chara A
authors.initials: CA
authors.lastname: Ntala
authors.affiliation: Queen's Hospital Burton-on-Trent, United Kingdom.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Nagy
authors.affiliation: Dumfries & Galloway Royal Infirmary, United Kingdom.
authors.forename: Evan O
authors.initials: EO
authors.lastname: Crane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery*; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D007718:Knee Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011044:Poland; D011446:Prospective Studies; D011859:Radiography / Q000592:standards*; D012189:Retrospective Studies; D014965:X-Rays; D055815:Young Adult