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The early diagnosis of sacroiliac joint infections in children
Mark Grippi1, Lewis E Zionts, Elke R Ahlmann
1Department of Orthopaedics, Los Angeles County, University of Southern California Medical Center, 1200 N. State Street, GNH 3900, Los Angeles, CA 90033, USA.
Insights
Early diagnosis of pediatric sacroiliac joint infections relies on clinical and laboratory findings, as imaging may be inconclusive in the initial stages. Prompt identification is crucial for effective treatment.
Area of Science:
- Pediatric infectious diseases
- Musculoskeletal infections
- Diagnostic imaging
Background:
- Sacroiliac joint infections in children are rare but serious conditions.
- Early diagnosis is challenging due to non-specific symptoms and initial negative imaging.
- Prompt treatment is essential to prevent complications.
Purpose of the Study:
- To evaluate the utility of various diagnostic methods for early detection of pediatric sacroiliac joint infections.
- To identify key clinical and laboratory indicators for timely diagnosis.
Main Methods:
- Retrospective review of medical records and imaging for 15 children with sacroiliac joint infections.
- Analysis of clinical presentation, physical examination, laboratory data, and imaging results (radiographs, bone scans, MRI).
Main Results:
- Fever (87%) and sacroiliac joint tenderness were common presenting signs.
- Blood cultures were positive in 46% of cases, often with Staphylococcus aureus.
- Conventional radiographs were largely unhelpful; bone scans (70%) and MRI (93%) were ultimately positive, but often delayed.
- Imaging within 6 days of symptom onset showed reduced sensitivity (bone scan 63%, MRI 57%).
Conclusions:
- Clinical and laboratory findings are paramount for the early diagnosis of pediatric sacroiliac joint infections.
- Diagnostic imaging, while ultimately useful, may not confirm the infection in the early symptomatic period.
- A high index of suspicion based on clinical presentation and lab results is critical for timely intervention.
Unlabelled:
We retrospectively reviewed the medical records and imaging studies of 15 children with infections of the sacroiliac joint to determine the usefulness of specific examinations and studies to aid in the early diagnosis of this condition. The clinical presentation, physical examination findings, pertinent laboratory data, and imaging studies were reviewed. Thirteen patients (87%) were febrile at the time of presentation. One patient presented in septic shock requiring intubation and critical care management. Tenderness to palpation over the sacroiliac joint was present in all 9 patients who had this examination performed, and the flexion abduction external rotation test was positive in 10 of 12 patients (83%) who had this test done. Laboratory indicators of infection were elevated in most patients, and 6 patients (46%) had positive blood cultures, most commonly growing Staphylococcus aureus. Initial conventional radiographs were negative in all but 1 patient. Radionuclide 99-m-technetium bone scans were positive in 7 of 10 patients (70%), and magnetic resonance imaging studies were ultimately positive in 13 of 14 patients (93%). However, within the first 6 days after the onset of symptoms, only 5 of 8 bone scans (63%) and 5 of 9 magnetic resonance imaging studies (57%) were consistent with infection. We conclude that while diagnostic imaging studies are ultimately helpful in confirming the diagnosis of sacroiliac joint infections in children, studies made within 6 days of the onset of symptoms may not always confirm the diagnosis. The early diagnosis of this condition is best made on the basis of clinical and laboratory findings.
Level Of Evidence:
Therapeutic Study, level IV (Case series [no, or historical control group]).
