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Sensitivity of objective parameters in the diagnosis of pediatric septic hips
D M Klein1, C Barbera, S T Gray
1Department of Orthopaedics and Rehabilitation, State University of New York, Brooklyn 11203-2098, USA.
Insights
Erythrocyte sedimentation rate (ESR) is the most sensitive indicator for diagnosing pediatric septic arthritis of the hip in children aged 0-6 years. While temperature and leukocyte count can be normal, ESR is consistently elevated in these cases.
Area of Science:
- Pediatric infectious diseases
- Orthopedic surgery
- Diagnostic marker evaluation
Background:
- Septic arthritis of the hip is a serious condition in children.
- Accurate and timely diagnosis is crucial for optimal outcomes.
- Identifying sensitive diagnostic markers in pediatric populations is essential.
Purpose of the Study:
- To evaluate the diagnostic sensitivity of temperature, leukocyte count, and erythrocyte sedimentation rate (ESR) in pediatric septic arthritis of the hip.
- To compare the effectiveness of these markers in children aged 0 to 6 years.
- To determine the most reliable indicator for this condition in young children.
Main Methods:
- Retrospective case analysis of 26 children (0-6 years) diagnosed with septic arthritis of the hip.
- Review of presenting temperature, leukocyte count, and ESR values.
- Analysis of marker sensitivity, including subgroup analysis for neonates.
Main Results:
- Erythrocyte sedimentation rate (ESR) showed the highest sensitivity (95% elevated >20 mm/hr), with only 5% of patients having a normal ESR.
- Temperature and leukocyte count had lower sensitivity, with 35% and 27% of patients, respectively, presenting with normal values.
- Neonates (age <1 month) often lacked fever and elevated leukocyte counts but showed elevated ESR (average 45 mm/hr).
Conclusions:
- Erythrocyte sedimentation rate (ESR) is the most sensitive diagnostic indicator for septic arthritis of the hip in children aged 0 to 6 years.
- Temperature and leukocyte count are less reliable, especially in neonates.
- ESR should be a primary consideration in the diagnostic workup of suspected pediatric hip septic arthritis.
Abstract:
This study examines the sensitivity of temperature, leukocyte count, and erythrocyte sedimentation rate in the diagnosis of pediatric septic arthritis of the hip by retrospective case analysis of 26 children, aged 0 to 6 years, in hospitals of central Brooklyn. The average presenting temperature was 38.4 degrees C, with 65% of the patients having had a temperature higher than 38 degrees C. The average leukocyte count was 13,500 per mL, with 73% of patients having a leukocyte count greater than 9000 per ml. The average erythrocyte sedimentation rate (21 cases) was 51 mm per hour, with 95% of the patients presenting with an erythrocyte sedimentation rate greater than 20 mm per hour. Of these children with septic hips, only 5% had a normal erythrocyte sedimentation rate, although 35% had a normal temperature and 27% had a normal leukocyte count. Neonates (age younger than 1 month) were not febrile (average temperature, 36.7 degrees C) and did not have an elevated leukocyte count (average leukocyte count, 9300 per mL) but did have an elevated erythrocyte sedimentation rate (average erythrocyte sedimentation rate, 45 mm per hour). Of these 3 values, erythrocyte sedimentation rate is the most sensitive indicator of septic arthritis of the hip in children 0 to 6 years of age.