Septic Arthritis, or Transient Synovitis?

4 May, 2011 by: colinparker

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There must be a combination of clinical features and/or tests that can help us figure out whether the limping child has a benign, self-limiting “irritable hip” or the scary and serious condition of pus in the joint: septic arthritis. It turns out that Dr Kocher has been working on this for years, and a few other investigators have worked at validating the results of the original 1999 study.

Our mission on this PEMcast is to make some sense of the clinical and laboratory factors that help us to risk stratify for Septic Arthritis. We delve into the literature, and give our synopsis of the few papers that address this important clinical dilemma… When should we get blood tests, and when can we safely reassure parents that watchful waiting is the best course of action?


Overview: Septic Arthritis PEMcast

[CP] BestBETs article (Taekema 2009)

Which refers to:

[KB] Kocher 1999

[CP] Jung 2003

[RR] Kocher 2004

[KB] Luhmann 2004

[CP] Caird 2006

[RR] Sultan 2010 JBJS – overview

[ALL] Bottom line, own experiences

[cp] Goodbye, thanks…

References

Taekema HC, Landham PR, Maconochie I.
Towards evidence based medicine for paediatricians. Distinguishing between transient synovitis and septic arthritis in the limping child: how useful are clinical prediction tools?
Arch Dis Child. 2009 Feb;94(2):167-8. Review. PubMed PMID: 19158141.

Kocher MS, Zurakowski D, Kasser JR.
Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm.
J Bone Joint Surg Am. 1999 Dec;81(12):1662-70. PubMed PMID: 10608376.

Jung ST, Rowe SM, Moon ES, Song EK, Yoon TR, Seo HY.
Significance of laboratory and radiologic findings for differentiating between septic arthritis and transient synovitis of the hip.
J Pediatr Orthop. 2003 May-Jun;23(3):368-72. PubMed PMID: 12724602.

Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR.
Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children.
J Bone Joint Surg Am. 2004 Aug;86-A(8):1629-35. PubMed PMID: 15292409.

Luhmann SJ, Jones A, Schootman M, Gordon JE, Schoenecker PL, Luhmann JD.
Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithms.
J Bone Joint Surg Am. 2004 May;86-A(5):956-62. PubMed PMID: 15118038.

Caird MS, Flynn JM, Leung YL, Millman JE, D’Italia JG, Dormans JP.
Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study.
J Bone Joint Surg Am. 2006 Jun;88(6):1251-7. PubMed PMID: 16757758.

Sultan J, Hughes PJ.
Septic arthritis or transient synovitis of the hip in children: the value of clinical prediction algorithms.
J Bone Joint Surg Br. 2010 Sep;92(9):1289-93. PubMed PMID: 20798450.

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