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Published on: February 25, 2022
Diagnosing acute bone and joint infection in children
Tim Theologis1, Mariea A Brady2, Stuart Hartshorn3
1Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK.
Insights
Differentiating childhood bone and joint infections from transient synovitis is crucial. This study aims to improve diagnostic accuracy by integrating imaging into decision support tools for better clinical outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Accuracy Research
- Medical Imaging in Pediatrics
Background:
- Acute bone and joint infections in children pose significant risks, including limb and life-threatening complications.
- Misdiagnosis is common, with many children presenting with symptoms similar to transient synovitis, a benign condition.
- Current diagnostic tools lack methodological rigor and do not adequately incorporate imaging modalities like ultrasound and MRI.
Purpose of the Study:
- To address the diagnostic challenge in differentiating pediatric osteoarticular infections from other conditions.
- To develop an evidence-based decision support tool that integrates imaging findings.
- To reduce diagnostic errors and ensure timely, appropriate treatment for children with bone and joint infections.
Main Methods:
- Initiation of a large UK multicentre study funded by the National Institute for Health Research.
- Focus on integrating the role of imaging (ultrasound and MRI) into diagnostic algorithms.
- Collaboration with experts in clinical prediction tool development.
Main Results:
- The study is in its initial stages, focusing on establishing the foundational methodology.
- Preliminary work involves defining the role and optimal use of various imaging techniques.
- The research aims to provide evidence for the utility of imaging in acute pediatric bone and joint infections.
Conclusions:
- There is a critical need for improved diagnostic strategies for acute bone and joint infections in children.
- Integrating imaging into decision support tools holds promise for enhancing diagnostic accuracy.
- This research seeks to standardize and improve clinical practice in managing pediatric bone and joint infections.
Abstract:
Acute bone and joint infections in children are serious, and misdiagnosis can threaten limb and life. Most young children who present acutely with pain, limping, and/or loss of function have transient synovitis, which will resolve spontaneously within a few days. A minority will have a bone or joint infection. Clinicians are faced with a diagnostic challenge: children with transient synovitis can safely be sent home, but children with bone and joint infection require urgent treatment to avoid complications. Clinicians often respond to this challenge by using a series of rudimentary decision support tools, based on clinical, haematological, and biochemical parameters, to differentiate childhood osteoarticular infection from other diagnoses. However, these tools were developed without methodological expertise in diagnostic accuracy and do not consider the importance of imaging (ultrasound scan and MRI). There is wide variation in clinical practice with regard to the indications, choice, sequence, and timing of imaging. This variation is most likely due to the lack of evidence concerning the role of imaging in acute bone and joint infection in children. We describe the first steps of a large UK multicentre study, funded by the National Institute for Health Research, which seeks to integrate definitively the role of imaging into a decision support tool, developed with the assistance of individuals with expertise in the development of clinical prediction tools.
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