Adequacy of Clinical Information in Knee Radiography Requests With Reference to the Pittsburgh Knee Rule: A Single-Centre Clinical Audit
Year: 2026
Type: article
Abstract: Background and objective Knee radiographs are frequently requested following acute knee injury, although the proportion demonstrating a fracture is relatively small. The Pittsburgh Knee Rule (PKR) is a validated clinical decision rule developed to support selective radiography following a fall or blunt knee trauma. Assessment of the rule, however, depends on adequate documentation of the relevant clinical findings. This clinical audit aimed to assess the adequacy of PKR-related clinical information documented on knee radiograph requests at a district general hospital with reference to the Royal College of Radiologists (RCR) AuditLive standard. Secondary objectives were to determine fracture yield and identify areas for improvement in request documentation. Materials and methods A single-centre retrospective clinical audit was undertaken. A total of 300 knee radiograph records were initially identified from two source lists. Ninety-five records were excluded during initial eligibility screening because they fell outside the predefined audit population, and three repeated or duplicate records were subsequently removed during dataset consolidation, resulting in 202 requests for analysis. The original radiology requests and corresponding imaging reports were reviewed for patient age, documented mechanism of injury, weight-bearing information, and radiographic evidence of acute fracture. The PKR was considered applicable where a fall or blunt-trauma mechanism was documented. Requests were classified as documented PKR-positive, documented PKR-negative, indeterminate because of insufficient documentation, or PKR not applicable where the documented mechanism fell outside the intended scope of the rule. Results Of 202 knee radiograph requests, 83 (41.1%) were classified as documented PKR-positive, 78 (38.6%) as indeterminate because of insufficient documentation, and 41 (20.3%) as PKR not applicable. No request contained sufficient information to establish a confidently documented PKR-negative status. Acute fractures were identified in 19/202 (9.4%) examinations. Fractures occurred in 15/83 (18.1%) documented PKR-positive requests and 4/78 (5.1%) requests with indeterminate documentation. No fractures occurred among the 41 requests classified as PKR not applicable. Conclusions A substantial proportion of knee radiograph requests lacked sufficient documented clinical information to permit reliable assessment with reference to the PKR. These findings reflect information available within radiology requests rather than confirmed real-time application of the rule by requesting clinicians. Absence of a documented criterion should not be interpreted as evidence that the corresponding clinical finding was absent or that radiography was inappropriate. An educational intervention was subsequently introduced, with a second audit cycle planned to assess improvement in documentation.
Source: Cureus
Authors: Paras Shrestha, Jae Yong Park
Institution: Dartford And Gravesham NHS Trust
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7213978293