Emergency Department Point-of-Care Hip Ultrasound and Its Role in the Diagnosis of Septic Hip Arthritis

Garrison, Jessica; Nguyen, Margaret B.; Marin, Jennifer R.

doi:10.1097/pec.0000000000000874

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…It is also useful in identifying fluid collections within the soft tissues, which may be suggestive of a soft tissue abscess. 22 It is recommended that plain radiographs should be used to exclude bone fractures. 23 USG has been recommended in children under 8 years old.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Patients Presenting to a Pediatric Emergency Department with Acute Limping

Şahin¹

2017

cayd

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Introduction:Limping is a common presenting complaint to a pediatric emergency department among children. The differential diagnosis of acute limp includes transient synovitis, trauma, infections, neoplasia, and congenital neuromuscular and developmental disorders. We aimed to evaluate patients presenting with acute limp to our pediatric emergency department and to analyze the clinical characteristics of the disease. In addition, we aimed to investigate the value of several laboratory parameters in early identification of septic and aseptic conditions. Methods: We retrospectively analyzed children under 18 years of age who were admitted to our emergency department with acute limping in a two-year period. Patients with any chronic diseases, any history of trauma, coagulopathy (as documented by blood clotting tests) and any history of intramuscular injections within the previous week were excluded. The patients' complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, plain pelvic radiographs and ultrasonography reports were evaluated. The patients were classified as septic or aseptic according to their white blood cells (WBC), CRP and ESR values. Totally 120 patients were included in the study. The upper limit for WBC, ESR and CRP was accepted as 9000 cells/mm 3 , 20 mm/h and 0.8 mg/dL, respectively. Results: Of the total of 86 patients in the aseptic group, 81 had normal WBC, ESR and CRP levels and were diagnosed with transient synovitis, 2 female patients received the diagnosis of slipped upper femoral epiphysis, and 3 patients were diagnosed with Legg-Calvé-Perthes disease during clinical follow-up. The remaining 34 patients with high ESR, WBC and CRP levels were included in the septic group in whom the following diagnoses were established during the follow-up: septic arthritis (n=12), Familial Mediterranean Fever (n=4), juvenile rheumatoid arthritis (n=4), GuillainBarré syndrome (n=3), osteomyelitis (n=3), acute rheumatic fever (n=3), spondyloarthritis (n=3) and Ewing sarcoma (n=2). There was a significant difference in CRP and WBC values between the septic and the aseptic groups, but no significant difference was found in ESR values. Conclusion: Acute atraumatic limp is a commonly encountered condition in children presenting to pediatric emergency departments. Transient synovitis is the most common cause of limping. CRP and WBC are two sensitive markers for diagnosing infectious and malignant etiology in this group of children. Keywords: Child, limping, acute Amaç: Aksama çocuklarda yaygın bir acil servise başvuru nedenidir. Normal yürüyüş paternine göre asimetrik bir tarz oluşması şeklinde tanımlanabilir. Ayırıcı tanısında geçici sinovit, travma, enfeksiyon, tümör veya enflamatuvar nedenler, doğuştan nöromusküler hastalıklar veya gelişimsel bozukluklar düşünülmelidir. Bu çalışmada çocuk acil servisine ani gelişen aksama ile başvuran hastaların sonuçlarını değerlendirmeyi ve bulgularımıza göre hastaların tanı ve takip açısından bazı ipuçları elde etmeyi planlayıp, septik v...

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Section: Discussionmentioning

confidence: 99%

Analysis of Patients Presenting to a Pediatric Emergency Department with Acute Limping

Şahin¹

2017

cayd

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“…18,19 Simple applications, such as the identification of a hip effusion, can rapidly locate the reason for a child's limp but cannot differentiate transient synovitis from septic arthritis. 20 Constipation is a clinical diagnosis that can be supported by POCUS, providing objective feedback to parents while avoiding the temptation to conduct unnecessary radiographs. 21,22 Global cardiac function, the filling of the inferior vena cava and the 'wetness' of the lungs can guide fluid resuscitation in shock, which can be difficult to discern from physiological parameters and clinical assessment alone in the paediatric population.…”

Section: Seeing Is Believingmentioning

confidence: 99%

Paediatric emergency medicine point‐of‐care ultrasound: Fundamental or fad?

Snelling

Tessaro

2017

Emerg Medicine Australasia

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“…In the last decade, point-of-care ultrasound (POCUS) has been increasingly used to detect hip effusions in the emergency department (ED). [3][4][5] Point-of-care ultrasound has additionally been reported to be effective in guiding hip aspirations performed by orthopedic surgeons in the ED. 6,7 This retrospective case series describes the clinical course of 10 children who had POCUS-guided hip aspirations performed by an ED physician.…”

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confidence: 99%

Point-of-Care Ultrasound-Guided Aspiration of the Hip Joint by an Emergency Medicine Physician

2022

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Emergency Department Point-of-Care Hip Ultrasound and Its Role in the Diagnosis of Septic Hip Arthritis

Abstract: We present a case of an 11-year-old girl with eye swelling and hip pain and the use of point-of-care hip ultrasound (US) to facilitate diagnosis of a septic hip. We review the US technique, sonographic findings, and relevant literature regarding point-of-care hip US.

Cited by 7 publications

References 12 publications

Analysis of Patients Presenting to a Pediatric Emergency Department with Acute Limping

Analysis of Patients Presenting to a Pediatric Emergency Department with Acute Limping

Paediatric emergency medicine point‐of‐care ultrasound: Fundamental or fad?

Point-of-Care Ultrasound-Guided Aspiration of the Hip Joint by an Emergency Medicine Physician

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