Developments in diagnosis and treatment of paediatric septic arthritis

Donders, Cornelia M.; Spaans, Anne J.; Wering, H van; Bergen, Christiaan JA van

doi:10.5312/wjo.v13.i2.122

Cited by 21 publications

(13 citation statements)

References 56 publications

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“…Septic arthritis and transient synovitis in children can sometimes be difficult to differentiate; however, accurate diagnosis is crucial for initiating different treatments and avoiding complications [18]. There is no simple test with high sensitivity, specificity, and ease of administration, to distinguish between the two conditions [19].…”

Section: Discussionmentioning

confidence: 99%

Clinical prediction model performance in differentiating septic arthritis from transient synovitis: A multi-center study

Qiu,

Deng,

Tang

et al. 2024

Preprint

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ObjectiveDifferentiating septic arthritis from transient synovitis in children is challenging. This study aimed to determine the diagnostic value for distinguishing these two conditions and to develop an effective clinical prediction model based on multi-center clinical data.MethodsWe retrospectively analyzed data of children aged under 18 years who were hospitalized in eight specialized children’s hospitals in China from 2013 to 2021. To ensure the prediction model’s reliability, we established three clinical prediction models.ResultsThis study collected data of 819 children from 8 tertiary children’s hospitals, including 265 patients with septic arthritis and 554 patients with transient synovitis.We established three clinical prediction models. For septic hip arthritis, a retrospective study based on six clinical predictors was a history of prodromal respiratory tract infection (HRTI), temperature>37.5 °C, ESR>20 mm/h, CRP>10 mg/L, red blood cell distribution width (RDW)>50%, and WBC>11×109 /L. When these six factors were present, the probability of septic hip arthritis was 99.99%.For septic knee arthritis, a retrospective study based on three clinical predictors, the predictors were ESR>20 mm/h, CRP>10 mg/L, and absolute monocyte count (AMONO)>0.74×109/L. When these three factors were present, the probability of having septic knee arthritis was 94.68%. For septic arthritis (septic hip arthritis or septic knee arthritis), a retrospective study based on six clinical predictors, the predictors were male children, history of HRTI), temperature>37.5 °C, ESR>20 mm/hr, PC > 407 × 109/L and CRP>10 mg/L. When these six factors were present, the probability of septic arthritis was 99.65%.ConclusionThis study used multi-center clinical data to construct a new clinical prediction model for children with septic arthritis. In addition we identified new clinical predictors such as sex, history of HRTI, RDW, PC and AMONO.Translational potentialA clinical prediction model, built on multi-center data, is capable of effectively making high-precision predictions for septic arthritis. Furthermore, based on the microbial characteristics of septic arthritis in children, we aim to develop diagnostic kits that can accurately and quickly detect infections caused by pathogens such as bacteria.

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Section: Discussionmentioning

confidence: 99%

Clinical prediction model performance in differentiating septic arthritis from transient synovitis: A multi-center study

Qiu,

Deng,

Tang

et al. 2024

Preprint

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“…Hopefully, prospective studies can identify more precise factors. It can cause permanent joint damage and death if it is not treated, although it is rare [1,3,18,20,21] . None of our patients had died.…”

Section: Discussionmentioning

confidence: 99%

Analysis of septic arthritis in a sample of Syrian population: a retrospective study

Khalayli,

Shahada,

Kudsi

et al. 2023

International Journal of Surgery: Global Health

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Introduction: This study found an increasing incidence and cost burden of septic arthritis because there are no criteria guiding the decision to perform arthrocentesis in adults. In this study, the authors aimed to determine whether arthrocentesis can be used as a diagnostic criterion for suspected septic arthritis. Methods: This retrospective cross-sectional study was conducted in our rheumatology department, and include patients aged greater than 18 years with mono-arthritis suspected to be septic arthritis. The exclusion criteria were prosthetic joints, inflammatory arthritis, participation in the study, and the inability to provide informed consent. Information was registered, including demographic data, smoking, alcoholism, comorbidities, BMI, symptoms and signs via medical history, clinical examinations (joint pain, local fever, and range-of-motion), fever (temperature >38°C), and laboratory markers including white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. The patients were divided into two groups: group 1 (patients who had arthrocentesis) and group 2 (patients who did not). The authors also divided patients who had arthrocentesis into two subgroups: patients with septic arthritis and patients without. Arthrocentesis was done. Results: A total of 256 patients were entered in our study, divided into two groups according to arthrocentesis. In all patients, the joint involved was the knee. Group 1 included 142 knee-aspirated patients (55.46%), and group 2 included 114 nonaspirated patients (44.53%). All aspirations were performed without image guidance. The ages, laboratory markers, physical exams, and comorbidities were not significant between the two groups on multivariate analysis. Synovial cultures were positive in 75.67% of patients. Staphylococcus aureus was the most common germ. No patient had died. The authors did not find any predictive risk factors for whether a joint was septic or not. Fever was significantly more frequent in joint-aspirated patients with septic arthritis. Conclusion: The aspiration decision is still the best in clinical practice in light of available clinical and laboratory findings, although further multicenter, larger studies are needed. Based on our findings, the authors decided to aspirate the joint based on positive guided findings and comorbidity risk factors.

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“…Septic arthritis is a bacterial infection of the joint space and is considered an orthopedic emergency as delay in diagnosis and treatment can lead to severe joint damage, disability, and need for joint replacement. 4 In the United States, the incidence of septic arthritis is 3 to 4 per 100,000 children, most commonly in ages 0 to 4. The most affected joints are the hip (32%-39%) and knee (26%-47%), with the ankle making up just 9% to 18% of cases.…”

Section: Review Of the Literaturementioning

confidence: 99%

Point-of-Care Ultrasound-Guided Arthrocentesis of a Pediatric Septic Ankle

Daly,

Moake,

Cummings

2024

Pediatr Emer Care

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Septic arthritis is one potential cause of pediatric joint effusion and pain that may lead to significant morbidity. We present a case where point-of-care ultrasound was used to identify and aspirate a joint effusion in a pediatric patient with septic arthritis of the ankle, facilitating timely diagnosis and care. We review the technique for arthrocentesis of the ankle and literature on point-of-care ultrasound in the diagnosis of pediatric septic arthritis.

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Developments in diagnosis and treatment of paediatric septic arthritis

Cited by 21 publications

References 56 publications

Clinical prediction model performance in differentiating septic arthritis from transient synovitis: A multi-center study

Clinical prediction model performance in differentiating septic arthritis from transient synovitis: A multi-center study

Analysis of septic arthritis in a sample of Syrian population: a retrospective study

Point-of-Care Ultrasound-Guided Arthrocentesis of a Pediatric Septic Ankle

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