Efficiency of the bone scan for occult limping toddlers
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J Aronson1, K Garvin, J Seibert
1Section of Pediatric Orthopaedics, Arkansas Children's Hospital, Little Rock 72202.
Insights
Triphase scintigraphy (TTS) is a highly sensitive and specific imaging tool for diagnosing occult limping in toddlers. This test accurately localizes lesions and can safely rule out infection, allowing for outpatient observation and cost savings.
Area of Science:
- Pediatric Orthopedics
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Occult limping in toddlers presents a diagnostic challenge.
- Traditional diagnostic methods may lack sensitivity and specificity.
Purpose of the Study:
- To evaluate the efficacy of acute triphase 99mTc MDP scintigraphy (TTS) in diagnosing occult limping in toddlers.
- To compare TTS with other diagnostic modalities.
Main Methods:
- Prospective evaluation of 50 consecutive toddlers with undiagnosed limps.
- Acute triphase 99mTc MDP scintigraphy (TTS) was performed on all patients.
- Comparison with clinical assessment, temperature, WBC count, ESR, and plain radiography.
Main Results:
- TTS localized the lesion in 54% of patients.
- The test demonstrated high sensitivity (two false negatives) and specificity (one false positive).
- TTS was more accurate than other evaluated methods in identifying the cause of limping.
Conclusions:
- Acute triphase 99mTc MDP scintigraphy (TTS) is an essential, sensitive, specific, and predictive tool for evaluating occult limping in toddlers.
- Normal TTS results can safely guide outpatient observation, reducing healthcare costs.
- TTS effectively rules out infection, preventing missed diagnoses.
Abstract:
Fifty consecutive occult limping toddlers were prospectively evaluated by acute triphase 99mTc MDP scintigraphy (TTS) at Arkansas Children's Hospital from 1984 through 1989. Only patients with a limp that could not be diagnosed by an orthopaedist were included. TTS proved essential in localizing the lesion in 27 patients (54%). With only two false negatives and one false positive, this test was shown to be highly sensitive, specific, efficient, and predictive, especially as compared with temperature, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and plain radiography. Because no infections were missed by TTS, patients with a normal TTS could be safely observed as outpatients, saving thousands of health care dollars in this small series.