Sensitivity of Objective Parameters in the Diagnosis of Pediatric Septic Hips

Klein, David M.; Barbera, Carl; Gray, Scott T.; Spero, Charles R.; Perrier, Gregory; Teicher, Joel

doi:10.1097/00003086-199705000-00022

Cited by 79 publications

(28 citation statements)

References 11 publications

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“…It was similar to study by Klein, where he found that 95% presented with ESR greater than 20 mm per hour. 7 In our study about 25 patients had high CRP level on admission irrespective of age which was similar to study by Khachaturian's which they found 88% had an elevated CRP on admission. 8 In our study we had 57% of patients which showed growth of MRSA out of all the patients which tested positive in blood culture.…”

Section: Discussionsupporting

confidence: 89%

Risk factors for septic arthritis of hip in neonates and infants

Chaudhari

Gajjar²,

Menon

et al. 2017

Int J Res Orthop

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Background: Suppurative arthritis of hip is pyogenic inflammation of synovial membrane of the hip, usually due to bacterial infection. The main aim of early diagnosis and treatment of septic arthritis of hip is to prevent damage to articular cartilage and growth plate, give stable and painless hip and to resume normal development and prevent sequelae.Methods: Prospective interventional study consisted of 34 patients with 36 Hips septic arthritis of hip less than one year of age carried out at Department of Orthopedics of a tertiary care centre during August 2011 to December 2013. Risk factors and related laboratory investigations were carried out. Data entry and analysis was done by MS Excel 3.0.Results: In our study more than 70% patients presented after one week. Left sided hip involvement (59%) was more common followed by right hip (35%). Sex ratio of the study population was M: F-4:6. NICU admission was present in 94% cases. In many of our patients there were more than one risk factors like septicemia, low birth weight, jaundice and ventilator support. Conclusions: All NICU neonates should be handled with strict aseptic precaution.

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Section: Discussionsupporting

confidence: 89%

Risk factors for septic arthritis of hip in neonates and infants

Chaudhari

Gajjar²,

Menon

et al. 2017

Int J Res Orthop

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“…Discriminating these two diseases is difficult but important. Several studies [3,5,18,20] have been focused on differentiating septic arthritis from transient synovitis of the hip in children. Kocher et al [5] used retrospective data to develop a clinical prediction algorithm for differentiating the two conditions.…”

Section: Discussionmentioning

confidence: 99%

Septic Arthritis Versus Transient Synovitis of the Hip: Gadolinium-Enhanced MRI Finding of Decreased Perfusion at the Femoral Epiphysis

Kwack

Cho

Lee

et al. 2007

American Journal of Roentgenology

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OBJECTIVE. The purpose of this study was to identify differences in the MRI findings of septic arthritis and transient synovitis in patients with nontraumatic acute hip pain and hip effusion.MATERIALS AND METHODS. The MRI findings in nine patients with septic arthritis and 11 with transient synovitis were reviewed retrospectively. This study was approved by our institutional review board. The diagnoses were based on findings at physical examination, laboratory studies, and joint aspiration and bacteriologic study. The MRI findings were analyzed with emphasis on the grade of joint effusion, alterations in signal intensity in the soft tissues and bone marrow, and the presence of decreased perfusion at the femoral head.RESULTS. Low signal intensity on fat-suppressed gadolinium-enhanced T1-weighted coronal MRI suggesting decreased perfusion at the femoral head of the affected hip joint was seen in eight of nine patients with septic arthritis and in two of 11 patients with transient synovitis. Statistically reliable differences (p = 0.005) were found between the two groups. Alterations in signal intensity in the bone marrow were seen in three patients with septic arthritis but in none of the patients with transient synovitis. Decreased perfusion on fat-suppressed gadolinium-enhanced coronal T1-weighted MRI was seen in the six patients with septic arthritis who did not have alterations in signal intensity involving the bone marrow.CONCLUSION. Decreased perfusion at the femoral epiphysis on fat-suppressed gadolinium-enhanced coronal T1-weighted MRI is useful for differentiating septic arthritis from transient synovitis.

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“…Past studies have reported variable sensitivities of these ancillary tests for septic arthritis. The sensitivity of an elevated WBC ranges from 19% to 77%, 2,4-8,13-19,21,25-27,33 the sensitivity of an elevated ESR ranges from 71% to 94%, [2][3][4][5][6][7][8]14,15,[17][18][19][20][21]30,[33][34][35] and the sensitivity of a jWBC greater than 50,000 cells/mm 3 ranges from 0% to 92%. 1,3,[17][18][19]21,[25][26][27][28][29][30]33,36,37 Much of the literature consists of case series studies like ours, often with variable values for normal WBC, ESR, and jWBC.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the white blood cell count of the joint fluid (jWBC) is often used to help differentiate septic arthritis from other entities. Although it is known that septic arthritis is associated with elevations in WBC, ESR, and jWBC, the vast majority of the studies involve the pediatric population, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] with few studies exclusively in adults. [16][17][18][19][20][21] In addition, although several emergency medicine textbooks indicate that a jWBC greater than 50,000 cells/mm 3 is likely to be ''positive,'' the number at which a jWBC is considered ''negative'' for septic arthritis varies from 2,000 to 10,000 cells/mm 3 in different texts.…”

mentioning

confidence: 99%

Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Henderson

Dickman

et al. 2004

Acad Emergency Med

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It is difficult to differentiate septic arthritis from other causes of monoarticular arthritis solely with a history and physical examination. The clinician must rely on ancillary tests to make a diagnosis, such as the white blood cell count of peripheral blood (WBC), the erythrocyte sedimentation rate (ESR), and the white blood cell count of the joint fluid ( jWBC) obtained from arthrocentesis. Although it is known that septic arthritis is associated with abnormalities in these tests, the majority of the data are based on studies in the pediatric population. In addition, although several emergency medicine texts indicate that a jWBC greater than 50,000 cells/mm 3 is ''positive,'' it is known that septic arthritis can occur in patients with low jWBCs. Objectives: To determine whether specific ancillary tests have sufficiently high sensitivities to rule out septic arthritis in adults.Methods: This was a retrospective consecutive case series of patients from an urban emergency department (ED). Patients at least 18 years old who had septic arthritis confirmed by positive arthrocentesis culture or operative findings were included in the study. WBC greater than 11,000 cells/mm 3 , ESR greater than 30 mm/hr, and jWBC greater than 50,000 cells/mm 3 were considered elevated. Results: Seventy-three patients met the inclusion criteria. The sensitivities of an elevated WBC, ESR, or jWBC in adults who had septic arthritis were 48%, 96%, and 64%, respectively. There were broad ranges of WBC, ESR, or jWBC among the patients. More than one third of adult patients with septic arthritis had jWBCs less than 50,000 cells/mm 3 . All patients had an abnormality in at least one of these tests. Conclusions: The WBC, ESR, and jWBC are extremely variable in adults with septic arthritis. Laboratory tests do not rule out septic arthritis with accuracy.

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Sensitivity of Objective Parameters in the Diagnosis of Pediatric Septic Hips

Cited by 79 publications

References 11 publications

Risk factors for septic arthritis of hip in neonates and infants

Risk factors for septic arthritis of hip in neonates and infants

Septic Arthritis Versus Transient Synovitis of the Hip: Gadolinium-Enhanced MRI Finding of Decreased Perfusion at the Femoral Epiphysis

Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

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