The crucial differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. In 1999, Kocher et al introduced four clinical predictors which were highly predictive (99.6%) of septic arthritis. These included fever (temperature > or = 38.5 degrees C), inability to bear weight, white blood-cell count > 12.0 x 10(9) cells/L and ESR > or = 40 mm/hr; CRP > or = 20 mg/L was later added as a fifth predictor. We retrospectively evaluated these predictors to differentiate septic arthritis from transient synovitis of the hip in children over a four-year period in a primary referral general hospital. When all five were positive, the predicted probability of septic arthritis in this study was only 59.9%, with fever being the best predictor. When applied to low-prevalence diseases, even highly specific tests yield a high number of false positives and the predictive value is thereby diminished. Clinical predictors should be applied with caution when assessing a child with an irritable hip, and a high index of suspicion, and close observation of patients at risk should be maintained.
Clinical scenarioA 65-year-old woman presents to the emergency department with signs and symptoms of SBO. She had previously had an abdominal hysterectomy. Plain abdominal radiograph (AXR) is non-specific. You wonder whether abdominal CT would be useful in the management of a patient with presumptive SBO.
Search strategyMedline 1950 to March 2006 using the OVID interface, combined with manual cross-referencing (exp Intestinal obstruction/AND exp Intestine, Small/AND exp Tomography, X-Ray Computed/) AND ((intestinal adj obstruction) AND CT).mp. limit to (humans and English language).
Search outcomeA total of 491 papers were found of which 16 were relevant to the topic and one systematic review incorporating 11 of these papers (table 3).
CommentsPublished literature supports the use of CT as a sensitive and specific test for small bowel obstruction. The evidence supports the proposal that CT provides reliable information regarding cause of the obstruction and presence of bowel strangulation.c CLINICAL BOTTOM LINE CT is a useful investigation in patients presenting with suspected SBO.
There is insufficient evidence to recommend the use of capillary blood in the assessment of acid-base status in patients with diabetic ketoacidosis in the emergency setting; more research is needed to answer this question. Abstract A short cut review was carried out to establish whether warming local anaesthetic solution reduced the pain of infiltration. A total of 720 papers were found using the reported searches, of which 11 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are presented in table 2. It is concluded that warmed local anaesthetic solution is less painful than that at room temperature.
Introduction: Greater trochanteric pain syndrome (GTPS) is a common and disabling condition characterized by pain and tenderness at or around the trochanteric area. Extracorporeal shockwave therapy (ESWT) has been described as a method of treatment. The National Institute for Health and Clinical Excellence (NICE, UK) guidance suggests a possible benefit but with limited evidence.
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