Diagnostic utility of inflammatory markers in septic arthritis in pediatric patients in atertiary care hospital in Bangalore

Abstract

Objectives: Septic arthritis is a disease associated with serious morbidity to the patient. The causes of monoarticular arthritis are numerous, with septic arthritis being the most important entity. The diagnosis is rarely established by the history and physical examination, and the clinician is led to rely on ancillary tests.As there are very limited studies relating to the usefulness of CRP, synovial fluid WBCand ESR in diagnosing septic arthritis in the pediatric population, this study was donein pediatric population in a tertiary care hospital in Bangalore. Materials and Methods: This is a retrospective study done over a period of 24months from January 2017 to December 2018. The study population included all the suspected patients of septic arthritis. Their inflammatory markers like WBC count, ESR and CRP were compared with the culture of the synovial fluid. Results: Our records search identified 335 potential cases. 134 cases fulfilled the diagnostic criteria for septic arthritis out of the 335 included in the study. Sensitivity of ESR was: 98% using a cutoff of ≥10 mm/h and 94% using a cutoff of ≥15 mm/h. The sensitivity of CRP was 92% using a cutoff of ≥20 mg/L. synovial fluid sample with WBC of >50 000/μL of which >75% are polymorphonuclear cells is considered to suggest Septic arthritis. Conclusion: Using our data and comparing it with published data we propose that it is unnecessary to perform further investigation for septic arthritis in patients who have all three of: ESR value <15mm/h, WBC <50,000/μL and CRP value <20mg/l.