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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
Background:
The acutely limping child presents a significant diagnostic challenge.
Aim:
The purpose of this study was to create a clinically useful algorithm to allow exclusion of 'musculoskeletal sepsis' as a differential diagnosis in the child presenting with limp.
Methods:
Data were collected on all 286 limping children admitted to our centre over a 3-year-period. Using logistic regression analysis, the predictive model was constructed, to exclude infection.
Results:
Duration of symptoms, constitutional symptoms, temperature, white cell count and ESR were significantly different in children with musculoskeletal infection (P < 0.05). Multivariate analysis demonstrated that when all three variables of duration of symptoms >1, <5 days; temperature >37.0 degrees C; and ESR >35 mm/h were present, the predicted probability of infection was 0.66, falling to 0.01 when none were present.
Conclusion:
This multivariate model enables us to rule out musculoskeletal infection with 99% certainty in limping children with none of these three presenting variables.
