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The limping child: an algorithm to outrule musculoskeletal sepsis
R A Delaney1, B Lenehan, L O'sullivan
1Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland. Delaney.ruth@gmail.com
Irish Journal of Medical Science
|July 13, 2007
Summary
This study developed a diagnostic algorithm for limping children to exclude musculoskeletal sepsis. The model accurately rules out infection in children without key symptoms, improving diagnostic certainty.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease Diagnosis
Background:
- Limping in children poses a diagnostic challenge.
- Differentiating infection from other causes is critical.
Purpose of the Study:
- Develop a clinical algorithm to exclude musculoskeletal sepsis in limping children.
- Provide a tool for accurate differential diagnosis.
Main Methods:
- Analyzed data from 286 limping children over 3 years.
- Utilized logistic regression to construct a predictive model.
- Identified key variables for infection prediction.
Main Results:
- Symptom duration, constitutional symptoms, temperature, white cell count, and ESR differed significantly in infected children (P < 0.05).
- A multivariate model incorporating symptom duration (>1 to <5 days), temperature (>37.0°C), and ESR (>35 mm/h) predicted infection probability.
- Presence of all three variables yielded a 0.66 probability of infection; absence yielded 0.01.
Conclusions:
- The multivariate model accurately excludes musculoskeletal infection in limping children.
- Achieves 99% certainty in ruling out infection when key variables are absent.
- Offers a reliable method for clinical decision-making in pediatric limp.
