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An investigation into the etiology of irritable hip
D R Bickerstaff1, L M Neal, P O Brennan
1Sheffield Children's Hospital, South Yorkshire, England.
Insights
Investigating acute hip pain in children revealed that tests for infection are rarely positive and do not help determine the cause of an irritable hip. Ultrasound can detect effusions, but cannot differentiate between hip conditions.
Area of Science:
- Pediatric Orthopedics
- Pediatric Rheumatology
- Pediatric Emergency Medicine
Background:
- Acute hip pain is a common presentation in children.
- Determining the etiology of hip pain, particularly irritable hip, can be challenging.
- The role of extensive investigations in diagnosing irritable hip is unclear.
Purpose of the Study:
- To investigate the etiology of acute hip pain in children.
- To assess the necessity of multiple investigations for irritable hip.
- To evaluate the diagnostic value of clinical, hematological, serological, and bacteriological tests.
Main Methods:
- Prospective review of 111 children with acute hip pain.
- Clinical assessment, including history of infection.
- Hematological, serological, and bacteriological investigations.
- Ultrasound for effusion diagnosis.
Main Results:
- No definitive etiological factors identified through clinical, hematological, serological, or bacteriological tests for irritable hip.
- A history of infection did not correlate well with irritable hip diagnosis.
- Ultrasound diagnosed effusion in 71% of cases, but could not differentiate between patients with or without effusion.
- No clinical or investigative factors differentiated patients with or without effusion.
Conclusions:
- Extensive investigations to find infection sources in irritable hip are not warranted.
- These investigations are rarely positive, seldom impact management, and do not aid in etiological diagnosis.
- Focus should be on clinical assessment and ultrasound for effusion, rather than extensive infectious workup.
Abstract:
A prospective review has been made of 111 children who presented with acute hip pain to determine it's etiology and assess the need for multiple investigations at presentation. There was no clinical hematological, serological or bacteriological evidence to identify positively patients with an irritable hip, neither was there good correlation with a history of infection. An effusion was diagnosed by ultrasound in 71% but there were no factors, either clinically or by investigation, to differentiate between patients with or without an effusion. We conclude that multiple investigations to find a source of infection in patients with irritable hip are not warranted as they are rarely positive, seldom affect management and are of no help in investigating the etiology of irritable hip.