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The painful hip: evaluation of criteria for clinical decision-making
G F Eich1, A Superti-Furga, F S Umbricht
1Division of Diagnostic Radiology, The University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland. G.F.Eich@access.unizh.ch
Insights
Diagnosing painful hips in children is challenging. Hip ultrasound combined with fever, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels can efficiently differentiate septic arthritis from other conditions.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Rheumatology
Background:
- Painful hip in children poses diagnostic challenges, with clinical differentiation between septic arthritis, transient synovitis, and Perthes disease being difficult.
- Septic arthritis is a medical emergency requiring prompt recognition, while other conditions may be managed conservatively.
- No single test reliably differentiates these hip conditions in children.
Purpose of the Study:
- To evaluate the diagnostic value of clinical examination, laboratory tests, radiography, and hip ultrasound in differentiating pediatric hip conditions.
- To identify an efficient diagnostic approach for painful hips in children.
Main Methods:
- Retrospective analysis of 89 children with hip pain.
- Inclusion of clinical, laboratory, radiographic, and ultrasound data.
- Diagnosis confirmation based on established criteria.
Main Results:
- Hip ultrasound identified effusion in all septic arthritis cases.
- Septic arthritis diagnosis required hip effusion plus at least two of: fever, elevated ESR, elevated CRP.
- Radiographs had minimal impact on initial diagnosis of acute hip pain.
Conclusions:
- Hip ultrasound, body temperature, ESR, and CRP are effective in selecting children for hip joint aspiration.
- This approach can optimize diagnostic efficiency and reduce unnecessary radiographs and hospital admissions.
Unlabelled:
Children with a painful hip present a diagnostic challenge since clinical differentiation between septic arthritis, transient synovitis and Perthes disease may be difficult. Septic arthritis, a potentially life-threatening and debilitating medical emergency, requires early recognition for successful treatment, while transient synovitis and Perthes disease may be managed conservatively. An "ideal" single test for discrimination between these conditions is currently not available. We assessed the value of clinical examination and simple laboratory tests together with radiography and hip ultrasound in differentiating septic arthritis from transient synovitis and Perthes disease by analyzing the records of 89 children treated at our institution for hip pain. Ultrasound, radiographs, laboratory, clinical, and follow-up data were available for all the children. Diagnoses were made according to established criteria. Transient synovitis was present in 64 patients, septic arthritis in 8 (of whom 2 had additional osteomyelitis), and Perthes disease in 4. All children with septic arthritis had hip effusion shown by ultrasound and at least two of the following criteria: fever, elevation of erythrocyte sedimentation rate (ESR) and of C-reactive protein (CRP). None of the children without effusion on ultrasound or who lacked two or all criteria had septic arthritis. Radiographs had no significant impact on the decision-making in primary evaluation of acute hip pain.
Conclusion:
We conclude that investigation of painful hips in children, based on hip ultrasound, body temperature, ESR and CRP, may allow cases for hip joint aspiration to be selected efficiently and may reduce the number of radiographs and hospital admissions.