Related Experiment Videos
Septic arthritis versus transient synovitis of the hip: the value of screening laboratory tests
M A Del Beccaro1, A N Champoux, T Bockers
1Emergency Services, Children's Hospital and Medical Center, Seattle, WA 98105.
Insights
Screening laboratory tests and temperature can help differentiate septic arthritis from transient synovitis in children with hip pain. Elevated erythrocyte sedimentation rate or temperature suggests septic arthritis, warranting further investigation.
Area of Science:
- Pediatric Emergency Medicine
- Orthopedic Surgery
- Diagnostic Imaging
Background:
- Septic arthritis and transient synovitis are common causes of hip pain in children.
- Accurate differentiation is crucial for timely treatment and preventing long-term joint damage.
Purpose of the Study:
- To evaluate the diagnostic utility of initial body temperature and screening laboratory markers in distinguishing septic arthritis from transient synovitis of the hip in pediatric patients presenting to the emergency department.
Main Methods:
- Retrospective review of pediatric cases diagnosed with septic arthritis or transient synovitis of the hip.
- Analysis of initial body temperature, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count.
Main Results:
- Septic arthritis cases showed significantly higher initial temperatures, ESR, and WBC counts compared to transient synovitis.
- However, considerable overlap was observed in these parameters.
- A combination of ESR > 20 mm/hr and/or temperature > 37.5 C identified 97% of septic arthritis cases.
Conclusions:
- Initial temperature, ESR, and WBC count have overlapping diagnostic values for differentiating pediatric hip conditions.
- Children with irritable hip and ESR > 20 mm/hr or temperature > 37.5 C should be considered for diagnostic hip aspiration to rule out septic arthritis.
Study Objective:
To determine the diagnostic value of screening laboratory and initial body temperature data in differentiating septic arthritis of the hip from transient synovitis of the hip in children who present to the emergency department with a complaint of hip pain.
Design:
Retrospective review of cases of septic arthritis of the hip and transient synovitis of the hip in a 1:2.5 ratio.
Setting:
An urban regional children's hospital with 20,000 annual ED visits.
Results:
Ninety-four children with transient synovitis of the hip and 38 children with septic arthritis of the hip were identified. The children with septic arthritis of the hip had a significantly higher initial temperature (38.1 C versus 37.2 C, P = .000014), mean erythrocyte sedimentation rate (44 mm/hr versus 19 mm/hr, P = .000001), and mean WBC count (13,200/mm3 versus 11,200/mm3, P = .02). However, the degree of overlap in these variables was large. The combination of an erythrocyte sedimentation rate of more than 20 mm/hr and/or a temperature of more than 37.5 C identified 97% of all cases of septic arthritis of the hip.
Conclusion:
There is clinically significant overlap in the erythrocyte sedimentation rate, temperature, and WBC count in children with septic arthritis of the hip versus transient synovitis of the hip. All children with an irritable hip without a clearly identified source who have an erythrocyte sedimentation rate of more than 20 mm/hr or a temperature of more than 37.5 C should be considered for diagnostic hip aspiration.