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Clinical indicators for distinguishing septic arthritis from paediatric transient synovitis of the hip: a systematic
Tang QingSong1, Miao XinLing2, Ren Xiang3
1Orthopedics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China. 329177897@qq.com.
Insights
Fever, inability to bear weight, and elevated inflammatory markers like ESR and WBC can help distinguish septic arthritis from transient synovitis in children. These indicators are valuable for early diagnosis and preventing complications.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Septic arthritis (SA) of the hip is a severe infection with potentially irreversible complications in children.
- Differentiating SA from transient synovitis, a common cause of hip pain in pediatric patients, is critical for timely intervention.
- Previous studies on clinical indicators for SA diagnosis have yielded inconsistent results.
Purpose of the Study:
- To systematically evaluate the correlation of various clinical indicators in differentiating septic arthritis from pediatric transient synovitis of the hip.
- To identify reliable diagnostic markers for early detection of hip joint infections in children.
Main Methods:
- A systematic literature search was conducted following PRISMA guidelines across PubMed, Embase, and Cochrane Library databases up to September 2024.
- Eleven studies involving 1810 cases were included, assessing the predictive value of clinical indicators in children under 18.
- Risk of bias and study quality were evaluated using QUADAS-2 and RevMan 5.3, with meta-analysis performed using Stata MP-64.
Main Results:
- Meta-analysis identified a history of fever (OR=6.04) as a significant risk factor for septic arthritis.
- Non-weight-bearing status (OR=5.23), erythrocyte sedimentation rate (ESR) (OR=3.98), and serum white blood cell (WBC) count (OR=2.73) were also significant indicators.
- C-reactive protein (CRP) levels did not show statistical significance in differentiating the two conditions (OR=7.12).
Conclusions:
- History of fever, non-weight-bearing status, ESR, and serum WBC count are valuable and cost-effective clinical indicators for differentiating septic arthritis from transient synovitis in children.
- These findings can aid in clinical decision-making and potentially reduce the need for invasive diagnostic procedures.
- Further prospective studies are recommended to strengthen the reliability of these diagnostic markers.
Background:
Septic arthritis (SA) of the hip joint is a serious infection that can result in irreversible complications. Distinguishing septic arthritis from transient synovitis, the most common cause of hip pain in children, is crucial for preventing severe outcomes. Existing research has primarily focused on identifying clinical signs and laboratory findings that indicate high-risk patients who may need invasive diagnostic procedures; however, results have been inconsistent. This study aims to evaluate the correlation of various clinical indicators in differentiating septic arthritis from pediatric transient synovitis of the hip.
Methods:
This study followed the PRISMA guidelines rigorously and was registered with PROSPERO. We conducted a systematic search of PubMed, Embase, and Cochrane Library databases for relevant literature up to September 2024. Studies included in the analysis were required to evaluate the predictive value of clinical indicators distinguishing septic arthritis and transient synovitis of the hip in children under 18 years of age. The risk of bias and quality of the included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and RevMan 5.3. Data synthesis was performed using Stata MP-64 18.0 software to facilitate meta-analysis.
Results:
A total of eleven studies were ultimately included for the final analysis, comprising 1810 cases. The results of meta-analysis revealed that history of fever emerged as a significant risk factor for differentiating septic arthritis from pediatric transient synovitis of the hip (OR = 6.04, 95% CI = 2.44-14.97, P < 0.001). Other notable risk factors included non-weight-bearing status (OR = 5.23, 95% CI = 1.38-19.75, P = 0.015), erythrocyte sedimentation rate (OR = 3.98, 95% CI = 1.29-12.30, P = 0.017), and serum white blood cell count (OR = 2.73, 95% CI = 1.23-6.03, P = 0.013). In contrast, C-reactive protein was not a significant risk factor (OR = 7.12, 95% CI = 0.59-85.70, P = 0.122).
Conclusion:
The clinical indicators involving a history of fever, non-weight-bearing status, erythrocyte sedimentation rate, and serum white blood cell count have been identified as cost-effective routine tests with potential value in differentiating septic arthritis from pediatric transient synovitis of the hip. To enhance the reliability of these findings, further prospective studies are essential.
Clinical Trial Number:
Not applicable.
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