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Differentiating Kingella kingae septic arthritis of the hip from transient synovitis in young children

Pablo Yagupsky1, Gal Dubnov-Raz2, Amadeu Gené3

  • 1Clinical Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel.

The Journal of Pediatrics
|September 14, 2014
PubMed

Insights

The Kocher predictive algorithm is not sensitive enough to differentiate Kingella kingae hip infections from transient synovitis in young children. Further testing like blood cultures and nucleic acid amplification assays are recommended for accurate diagnosis.

Area of Science:

  • Pediatric Infectious Diseases
  • Orthopedic Infections
  • Diagnostic Accuracy Studies

Background:

  • Kingella kingae is a common cause of septic arthritis in young children.
  • Differentiating K. kingae hip infections from transient synovitis can be challenging due to overlapping clinical presentations.
  • The Kocher prediction algorithm is often used to assess the likelihood of septic arthritis.

Purpose of the Study:

  • To evaluate the effectiveness of the Kocher prediction algorithm in distinguishing pediatric hip infections caused by K. kingae from transient synovitis.
  • To identify optimal diagnostic strategies for K. kingae hip arthritis in young children.

Main Methods:

  • A retrospective multicenter study reviewed medical charts of children aged 6-27 months with culture-proven K. kingae hip arthritis.
  • Data on four Kocher algorithm variables (temperature, weight-bearing refusal, leukocytosis, ESR) were collected.
  • Diagnostic performance of the algorithm was assessed by comparing predicted probabilities with confirmed diagnoses.

Main Results:

  • Children with K. kingae arthritis often presented with mild clinical signs and normal or near-normal acute-phase reactants.
  • The Kocher algorithm yielded low scores (≤ 40% probability of infectious arthritis) in 71% of the studied K. kingae cases.
  • Significant overlap in clinical and laboratory findings between K. kingae arthritis and transient synovitis was observed.

Conclusions:

  • The Kocher prediction algorithm lacks sufficient sensitivity to reliably differentiate K. kingae hip arthritis from transient synovitis in children under three years.
  • Blood cultures and nucleic acid amplification assays are crucial for excluding K. kingae hip arthritis in young children with hip irritation, irrespective of fever, leukocytosis, or Kocher score.
  • Early and accurate diagnosis of K. kingae hip infections is essential to prevent long-term joint damage.
Abstract

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