1
|
Nannini A, Giorgino R, Bianco Prevot L, Bobba A, Curci D, Cecchinato R, Peretti GM, Verdoni F, Mangiavini L. Septic arthritis in the pediatric hip joint: a systematic review of diagnosis, management, and outcomes. Front Pediatr 2023; 11:1311862. [PMID: 38188916 PMCID: PMC10771295 DOI: 10.3389/fped.2023.1311862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Septic arthritis of the pediatric hip joint (SAH) is a rare but serious orthopedic emergency requiring immediate diagnosis and management. Delayed recognition can lead to severe complications, emphasizing the need for timely intervention. This systematic review aims to provide a comprehensive analysis of SAH in the pediatric population, focusing on its diagnosis, management, and outcomes. The review included 11 studies involving 391 patients with SAH, aged between three months and 12 years. Staphylococcus aureus was identified as the most common causative pathogen, with increasing cases of methicillin-resistant strains. Diagnosis is challenging due to nonspecific clinical presentations, necessitating validated criteria and a multidisciplinary approach. Ultrasound emerged as a valuable tool for early detection, and MRI was used in challenging cases. Treatment options include hip aspiration, arthrotomy, and arthroscopy, often combined with appropriate antibiotic therapy. Success rates were comparable among different surgical procedures. Early intervention is vital for optimal outcomes. However, the review highlights the need for standardized protocols and further prospective studies to address limitations and improve understanding and management of SAH in the pediatric hip joint.
Collapse
Affiliation(s)
- Alessandra Nannini
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Luca Bianco Prevot
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Andrea Bobba
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | - Giuseppe M. Peretti
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | | | - Laura Mangiavini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| |
Collapse
|
2
|
Abbas A, Laverde R, Yap A, Stephens CQ, Samad L, Seyi-Olajide JO, Ameh EA, Ozgediz D, Lakhoo K, Bickler SW, Meara JG, Bundy D, Jamison DT, Klazura G, Sykes A, Philipo GS. Routine Pediatric Surgical Emergencies: Incidence, Morbidity, and Mortality During the 1st 8000 Days of Life-A Narrative Review. World J Surg 2023; 47:3419-3428. [PMID: 37341797 PMCID: PMC10694096 DOI: 10.1007/s00268-023-07097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Many potentially treatable non-congenital and non-traumatic surgical conditions can occur during the first 8000 days of life and an estimated 85% of children in low- and middle-income countries (LMICs) will develop one before 15 years old. This review summarizes the common routine surgical emergencies in children from LMICs and their effects on morbidity and mortality. METHODS A narrative review was undertaken to assess the epidemiology, treatment, and outcomes of common surgical emergencies that present within the first 8000 days (or 21.9 years) of life in LMICs. Available data on pediatric surgical emergency care in LMICs were aggregated. RESULTS Outside of trauma, acute appendicitis, ileal perforation secondary to typhoid fever, and intestinal obstruction from intussusception and hernias continue to be the most common abdominal emergencies among children in LMICs. Musculoskeletal infections also contribute significantly to the surgical burden in children. These "neglected" conditions disproportionally affect children in LMICs and are due to delays in seeking care leading to late presentation and preventable complications. Pediatric surgical emergencies also necessitate heavy resource utilization in LMICs, where healthcare systems are already under strain. CONCLUSIONS Delays in care and resource limitations in LMIC healthcare systems are key contributors to the complicated and emergent presentation of pediatric surgical disease. Timely access to surgery can not only prevent long-term impairments but also preserve the impact of public health interventions and decrease costs in the overall healthcare system.
Collapse
Affiliation(s)
- Alizeh Abbas
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ruth Laverde
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ava Yap
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Caroline Q Stephens
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Lubna Samad
- Global Surgery Programs, Interactive Research & Development, Karachi, Pakistan
| | | | - Emmanuel A Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kokila Lakhoo
- Department of Pediatric Surgery, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Donald Bundy
- Global Research Consortium for School Health and Nutrition, London School of Hygiene and Tropical Medicine, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Greg Klazura
- Loyola University Medical Center, Chicago, IL, USA
| | - Alicia Sykes
- Naval Medical Center San Diego, San Diego, CA, USA
| | | |
Collapse
|
3
|
Clinical profiles and antimicrobial resistance patterns of invasive Salmonella infections in children in China. Eur J Clin Microbiol Infect Dis 2022; 41:1215-1225. [PMID: 36040531 PMCID: PMC9489584 DOI: 10.1007/s10096-022-04476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022]
Abstract
Invasive Salmonella infections result in a significant burden of disease including morbidity, mortality, and financial cost in many countries. Besides typhoid fever, the clinical impact of non-typhoid Salmonella infections is increasingly recognized with the improvement of laboratory detection capacity and techniques. A retrospective multicenter study was conducted to analyze the clinical profiles and antimicrobial resistance patterns of invasive Salmonella infections in hospitalized children in China during 2016–2018. A total of 130 children with invasive Salmonella infections were included with the median age of 12 months (range: 1–144 months). Seventy-nine percent of cases occurred between May and October. Pneumonia was the most common comorbidity in 33 (25.4%) patients. Meningitis and septic arthritis caused by nontyphoidal Salmonella (NTS) infections occurred in 12 (9.2%) patients and 5 (3.8%) patients. Patients < 12 months (OR: 16.04) and with septic shock (OR: 23.4), vomit (OR: 13.33), convulsion (OR: 15.86), C-reactive protein (CRP) ≥ 40 g/L (OR: 5.56), and a higher level of procalcitonin (PCT) (OR: 1.05) on admission were statistically associated to an increased risk of developing meningitis. Compared to 114 patients with NTS infections, 16 patients with typhoid fever presented with higher levels of CRP and PCT (P < 0.05). The rates of resistance to ampicillin, sulfamethoxazole/trimethoprim, ciprofloxacin, and ceftriaxone among Salmonella Typhi and NTS isolates were 50% vs 57.3%, 9.1% vs 24.8%, 0% vs 11.2%, and 0% vs 9.9%, respectively. NTS has been the major cause of invasive Salmonella infections in Chinese children and can result in severe diseases. Antimicrobial resistance among NTS was more common.
Collapse
|
4
|
Berant R, Bder M, Kaufman-Shriqui V, Shahar-Nissan K. Point-of-Care Ultrasound-Guided Aspiration of the Hip Joint by an Emergency Medicine Physician: A Pediatric Retrospective Case Series. Pediatr Emerg Care 2022; 38:139-142. [PMID: 35226624 DOI: 10.1097/pec.0000000000002650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Early administration of antibiotics is crucial to treating septic hip. This study aimed to describe the clinical course and outcomes of children with septic hip diagnosed using point-of-care ultrasound (POCUS)-guided hip aspirations performed by an emergency medicine physician. METHODS A retrospective case series analysis. RESULTS Between January 1, 2014, and December 31, 2019, 10 children with septic hip were diagnosed by emergency physicians using POCUS-guided hip aspirations. Six of them were female; the mean age was 4.2 ± 4.5 years, and the mean time from onset of symptoms to diagnosis was 2.9 ± 1.7 days. Seven patients (70%) had a history of fever. All the patients had elevated inflammatory blood markers (white blood cell count >12 K/μL, erythrocyte sedimentation rate >40 mm/h, or a C-reactive protein >2 mg/dL). The mean time from hospital arrival to the first antibiotic dose was 5.2 + 4.0 hours. All the children were discharged fully ambulatory and did not require rehospitalization or repeat aspiration after discharge. CONCLUSIONS This case series shows that POCUS-guided hip aspiration is both safe and feasible in diagnosing septic hip in the pediatric emergency department. The procedure enables rapid diagnosis and early initiation of antibiotic treatment, thus reducing the risk for complications related to delayed initiation of therapy.
Collapse
Affiliation(s)
| | | | - Vered Kaufman-Shriqui
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | | |
Collapse
|
5
|
Donders CM, Spaans AJ, van Wering H, van Bergen CJA. Developments in diagnosis and treatment of paediatric septic arthritis. World J Orthop 2022; 13:122-130. [PMID: 35317401 PMCID: PMC8891656 DOI: 10.5312/wjo.v13.i2.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/08/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
Acute septic arthritis in children is an orthopaedic emergency. A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence. The clinical presentation can be a diagnostic challenge, especially in young children. A recent systematic review showed that joint tenderness and fever are important signals of septic arthritis. Ultrasound is helpful in detecting the presence of a joint effusion. Plain radiographs may show bone changes but magnetic resonance imaging is the most reliable imaging study for detecting concomitant osteomyelitis. The diagnosis of acute septic arthritis is highly suggestive when pus is aspirated from the joint, in case of a positive culture or a positive gram stain of the joint fluid, or if there is a white blood-cell count in the joint fluid of more than 50000/mm3. Staphylococcus aureus is the most commonly cultured organism. Recent systematic reviews have identified the most effective drainage techniques, including needle aspiration, arthroscopy and arthrotomy, depending on the affected joint. After the drainage procedure it is important to monitor the clinical and laboratory outcomes. Additional drainage procedures may be necessary in select cases.
Collapse
Affiliation(s)
- Cornelia M Donders
- Department of Orthopaedic Surgery, Meander Medical Centre, Amersfoort 3813 TZ, Netherlands
| | - Anne J Spaans
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen 6574 NA, Netherlands
| | | | | |
Collapse
|
6
|
Skármeta NP, Espinoza-Mellado PA, Elissalt N, Diez FJ, Fumeaux JE. Infectious arthritis and the temporomandibular joint. A review. Cranio 2020; 41:190-198. [PMID: 32957846 DOI: 10.1080/08869634.2020.1819687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Microorganisms can cause acute infectious arthritis, chronic infectious arthritis, or reactive inflammatory arthritis. The aim of this study is to perform a narrative review of the pathophysiology, etiology, and diagnostic features of infectious arthritis and TMJ infectious arthritis. METHODS A search of the literature was performed using Medline, Scielo, Embase, and Google Scholar databases. The terms employed for the search were "Temporomandibular Joint Disorders" and "Infectious Arthritis"; or "Septic Arthritis"; or "Bacterial, Fungal, or Viral Arthritis." Over three hundred articles were screened for eligibility. RESULTS The selected articles were utilized to perform a narrative review of the general aspects of infectious arthritis and infectious arthritis affecting the TMJ. CONCLUSION Infectious arthritis is a rare, yet very morbid, form of arthritis. Understanding general aspects of joint infections and specific features of TMJ infectious arthritis is imperative for an adequate diagnosis.
Collapse
Affiliation(s)
- Nicolás Patricio Skármeta
- Orofacial Pain, Occlusion, and TMDs, Facultad de Odontología, Universidad San Sebastián, Santiago, Chile.,Orofacial Pain, OPH Dental, Santiago, Chile.,Orofacial Pain Hospital del Salvador, SSMO, Santiago, Chile
| | | | | | | | - Julienne Etienne Fumeaux
- Department of Oral and Maxillofacial Surgery, Hospital Clínico de la Fuerza Aérea de Chile, Santiago, Chile.,Department of Oral and Maxillofacial Surgery, Hospital del Trabajador, Asociación Chilena de Seguridad, Santiago, Chile
| |
Collapse
|
7
|
Qin Y, Zhou Z. [Research progress of total hip arthroplasty for patients with sequelae of suppurative hip arthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:139-144. [PMID: 31939249 DOI: 10.7507/1002-1892.201905083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize the research progress of total hip arthroplasty (THA) in treatment of sequelae of suppurative hip arthritis. Methods The relevant literature was systematically searched and the operation timing, treatments of acetabular and femoral sides, and prosthesis selection in THA for sequelae of suppurative hip arthritis were summarized. Results THA is an effective way to treat the sequelae of suppurative hip arthritis. In order to avoid the recurrence of infection, THA is recommended to be performed after 10 years of resting period of hip septic infection. These patients may have acetabulum dysplasia and poor coverage of acetabulum. When performing THA, high position acetabulum, osteotomy of the medial acetabular wall, structural bone graft, Cage, tantalum augment, or three-dimensional printing prosthesis can be chosen. The femoral side may has small medullary cavity, increased femoral neck anteversion, increased femoral neck-stem angle, extend trochanter, and poor bone mass. When performing THA, the femoral osteotomy and appropriate prosthesis can be selected for treatment. The patients with sequelae of suppurative hip arthritis are mostly young, cementless THA is preferred for a better long-term survivorship. Conclusion THA is an effective method for the sequelae of suppurative hip arthritis, but the operation is difficult and has relative high complication rate. Surgeons should have full understanding.
Collapse
Affiliation(s)
- Yongzhi Qin
- Department of Orthopedics, the People's Hospital of Guang'an City, Guangan Sichuan, 638000, P.R.China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| |
Collapse
|
8
|
Mohan A, Munusamy C, Tan YC, Muthuvelu S, Hashim R, Chien SL, Wong MK, Khairuddin NA, Podin Y, Lau PST, Ng DCE, Ooi MH. Invasive Salmonella infections among children in Bintulu, Sarawak, Malaysian Borneo: a 6-year retrospective review. BMC Infect Dis 2019; 19:330. [PMID: 30999894 PMCID: PMC6471830 DOI: 10.1186/s12879-019-3963-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background Invasive Salmonella infections result in significant morbidity and mortality in developing countries. In Asia, typhoid and paratyphoid fever are reported to be the major invasive Salmonella infections, while invasive non-typhoidal Salmonella (iNTS) infections are believed to be uncommon. Data from Sarawak, in Malaysian Borneo, are limited. Methods A retrospective study identifying all children aged < 15 years with invasive Salmonella infections from 2011 to 2016 was conducted in Bintulu Hospital in Sarawak. Population incidences, clinical and bacterial characteristics were examined. Results Forty-four patients were identified during the 6-year study period: 43 had iNTS infection and 1 had typhoid fever. The average annual iNTS incidence was 32.4 per 100,000 children aged < 5 years. None of the children had malaria or HIV infection, and only 7% were severely malnourished. Salmonella Enteritidis and Salmonella Java were the commonest NTS serovars identified. Pneumonia was the most common manifestation of iNTS disease, present in 20 (47%) children. Other manifestations included gastroenteritis, fever without a source, septic arthritis and meningitis. Salmonella Enteritidis was identified in 76% of those with pneumonia, significantly more frequently than in children with other manifestations. Over 25% of children with iNTS developed severe disease and nearly 10% suffered long term morbidity or mortality. While 78% of Salmonella Java isolates were multi-drug resistant, nearly all other isolates were susceptible to most antimicrobials, including ampicillin. Conclusions Bintulu Division in Sarawak observed a very high incidence of childhood iNTS infections. Enteric fever was uncommon. The epidemiology of invasive Salmonella infections in Malaysian Borneo differs considerably from that of neighbouring countries in Asia.
Collapse
Affiliation(s)
- Anand Mohan
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia. .,Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Chandran Munusamy
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Yee-Chin Tan
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Sobana Muthuvelu
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Rohaidah Hashim
- Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Su-Lin Chien
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Ming-Kui Wong
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | | | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | | | - David Chun-Ern Ng
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia.,Department of Paediatrics, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.,Department of Paediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| |
Collapse
|
9
|
Zeng WN, Liu JL, Jia XL, Zhou Q, Yang L, Zhang Y. Midterm Results of Total Hip Arthroplasty in Patients With High Hip Dislocation After Suppurative Hip Arthritis. J Arthroplasty 2019; 34:102-107. [PMID: 30342951 DOI: 10.1016/j.arth.2018.09.081] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is technically challenging in patients with high dislocation of the hip secondary to suppurative arthritis. The technical difficulty is attributable to the complex hip anatomy and the potential risk of recurrent infection in these patients. This study investigated the midterm results of THA in patients with Crowe type III and IV high dislocation of the hip secondary to suppurative arthritis. METHODS This study retrospectively reviewed 45 patients (45 hips) who underwent cementless THA with a mean quiescent infection period of 34.2 years. This study included 23 men and 22 women (mean age, 45.9 years) at the time of operation. The mean follow-up was 6.4 years. Clinical and radiographic outcomes and complications were evaluated. RESULTS The mean Harris hip score significantly improved from 48.1 to 87.6. The modified Merle d'Aubigné-Postel, Western Ontario and McMaster Universities Arthritis Index, low back pain visual analog scale, and the 12-item short-form health survey scores also improved significantly. The mean limb length discrepancy was reduced from 38.9 mm to 6.4 mm. Postoperative dislocation occurred in 2, temporary sciatic nerve paralysis in 3, and intraoperative fracture in 2 patients. Infection and femoral stem loosening necessitated hip revision surgery in 1 patient each. CONCLUSION THA could provide good joint function and significantly improve quality of life at the time of midterm follow-up in patients undergoing high hip dislocation secondary to suppurative arthritis. However, a relatively high incidence of complications occurred which can be treated.
Collapse
Affiliation(s)
- Wei-Nan Zeng
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun-Li Liu
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; Department of Orthopaedics, Chongqing General Hospital, Chongqing, China
| | - Xiao-Lin Jia
- Department of Orthopaedics, Chongqing General Hospital, Chongqing, China
| | - Qiang Zhou
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yun Zhang
- Department of Orthopedics of Traditional Chinese Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| |
Collapse
|
10
|
Lauper N, Davat M, Gjika E, Müller C, Belaieff W, Pittet D, Lipsky BA, Hannouche D, Uçkay I. Native septic arthritis is not an immediate surgical emergency. J Infect 2018; 77:47-53. [PMID: 29742468 DOI: 10.1016/j.jinf.2018.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/21/2018] [Accepted: 02/07/2018] [Indexed: 12/23/2022]
Abstract
Acute native joint septic arthritis is generally considered a surgical emergency, requiring drainage within hours, including during night, weekend or holiday shifts. However, there are few data supporting the need for the disruption caused by this degree of urgency. METHODS We performed a retrospective review of all adult patients seen in our medical center from 1997-2015 with culture-proven septic arthritis and noted the epidemiology of sequelae, and their possible association with a delay in surgical drainage. RESULTS Of 204 septic arthritis episodes, 46 (23%) involved interdigital hand and foot joints. Large joints involved included the knee (n = 67), shoulder (48), hip (22), ankle (8), acromio-clavicular (5), elbow (4), wrist (3), and sterno-clavicular (1) regions. All patients underwent surgical drainage of the joint and received targeted systemic antibiotic therapy. Sequelae of varying severity occurred in 83 patients (41%): recurrences (n = 15); secondary arthrosis (30); persistent pain (9); Girdlestone procedure (9); arthrodesis (9); amputation (8); stiffness (8); and Chronic Regional Pain Syndrome (2). By multivariate Cox regression analysis factors did not predict sequelae included: age; treatment with systemic corticosteroids; pre-existing clinical or radiological arthropathy; total duration of antibiotic therapy; type of joint; and, number of surgical interventions. Similarly, there was no association of sequelae with the number of days of pre-hospitalization joint symptoms (hazard ratio 1.0, 95% confidence interval 0.99-1.01) or hours spent in the emergency department (HR 1.0, 0.9-1.2). Notably, patients who had joint lavage within 6 h of presentation had similar functional outcomes as those with lavage done at 6-12 h, 12-24 h, or > 24 h after presentation. CONCLUSIONS Our data suggest that for native septic arthritis, in the absence of clinical sepsis immediate joint drainage does not appear to reduce the risk of sequelae compared with delayed drainage.
Collapse
Affiliation(s)
- Nicolas Lauper
- Orthopaedic Surgery Service, Geneva University Hospitals
| | - Marie Davat
- Orthopaedic Surgery Service, Geneva University Hospitals
| | - Ergys Gjika
- Orthopaedic Surgery Service, Geneva University Hospitals; Hand Surgery Unit, Geneva University Hospitals
| | - Camillo Müller
- Orthopaedic Surgery Service, Geneva University Hospitals; Hand Surgery Unit, Geneva University Hospitals
| | | | - Didier Pittet
- Service of Infectious Diseases, Geneva University Hospitals; Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benjamin A Lipsky
- Service of Infectious Diseases, Geneva University Hospitals; Division of Medical Sciences, University of Oxford, UK
| | | | - Ilker Uçkay
- Orthopaedic Surgery Service, Geneva University Hospitals; Service of Infectious Diseases, Geneva University Hospitals; Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
11
|
Abstract
Background: Pyogenic osteomyelitis is an important child health problem in developing countries. It is a one-disease state with a spectrum of pathological features and clinical forms ranging from acute to chronic presentation. Its pattern of presentation varies from and within subregions. The aim of this study was to determine the pattern and outcome of childhood pyogenic osteomyelitis in a low-resource environment. Materials and Methods: This was a retrospective study of all the children aged 18 years and under seen with pyogenic osteomyelitis in Federal Teaching Hospital Abakaliki between January 2005 and December 2015. Results: In 76 patients, there was pyogenic osteomyelitis involving 85 bones. Female-to-male ratio was 1:1.7, and the mean age was 9.9 ± 5.1 years. The clinical forms of presentation were acute in 16 (21.1%), subacute in 10 (13.2%), and chronic in 50 (65.8%) patients. Acute osteomyelitis was the more likely form of presentation among infants (P < 0.001) and urban children (P < 0.011) whereas subacute and chronic osteomyelitis were more likely among the older children (P < 0.001) and rural residents (P < 0.011). Staphylococcus aureus was the most common isolated pathogen. Anemia, septic arthritis, and pathological fractures were the three top complications observed. Fifty patients (65.8%) recovered and adjudged cured, 9 (11.8%) were lost to follow-up, and 17 (22.4%) were unable to afford the financial cost of the treatment. Conclusion: In our environment, chronic pyogenic osteomyelitis sequel to acute hematogenous bone infection in childhood is common. Poverty is also a limiting factor in its definitive treatment. These calls for a policy response aimed at improved care and preventive strategies based on the observed pattern.
Collapse
Affiliation(s)
- Njoku Isaac Omoke
- Department of Surgery, Ebonyi State University/Federal Teaching Hospital, Abakaliki, Nigeria
| |
Collapse
|
12
|
Pääkkönen M. Septic arthritis in children: diagnosis and treatment. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:65-68. [PMID: 29388627 PMCID: PMC5774603 DOI: 10.2147/phmt.s115429] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Acute septic arthritis in children is usually hematogenous. It is more common in boys, and it most often affects the large joints of the lower limb. Diagnosis is based on cultures obtained from the infected joint and is supported by C-reactive protein blood test or ultrasound imaging. Staphylococcus aureus is the most common causative agent and is the primary target for empiric treatment. First-generation cephalosporins and clindamycin are suitable antibiotics. Vancomycin is utilized in areas with high rates of clindamycin- and methicillin-resistant S. aureus. After a short intravenous administration of 2–4 days, a total course of 2 weeks is sufficient in uncomplicated cases. Early antibiotic treatment has significantly improved the prognosis in high-income settings, but uncomplicated recovery is compromised if the treatment is delayed. Complications such as symptomatic osteoarthritis or avascular necrosis of the femoral head develop slowly. A long follow-up of 1–2 years is required to detect all possible sequelae.
Collapse
Affiliation(s)
- Markus Pääkkönen
- Department of Pediatric Orthopaedic Surgery.,Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland
| |
Collapse
|
13
|
Omoke NI, Obasi AA. Childhood Pyogenic Septic Arthritis as Seen in a Teaching Hospital South East Nigeria. Niger J Surg 2017; 23:26-32. [PMID: 28584508 PMCID: PMC5441212 DOI: 10.4103/1117-6806.199968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Childhood pyogenic septic arthritis and its associated musculoskeletal morbidity is an important health concern in developing countries. Its pattern of presentation that varies from and within subregions has implications on the early recognition, treatment, and outcome. The aim of this study was to determine the pattern and outcome of childhood septic arthritis in our environment. MATERIALS AND METHODS This was a retrospective study of all the children seen with pyogenic septic arthritis in Federal Teaching Hospital Abakaliki between January 2005 and December 2015. RESULTS Childhood septic arthritis accounted for 44 (83%) of the 53 patients seen with pyogenic septic arthritis. Female to male ratio was 1:1.75 and the mean age was 5.7 ± 0.73 years. Eight patients (18.2%) had polyarticular involvements. The right shoulder was significantly more involved than the left and the left hip more than right. Overall, there was a preponderance of onset of symptoms in the dry season. Children from the rural areas accounted for 85.7% of those with the onset of symptom in rainy season. Delayed presentation >6 days (in 68.2% of patients) was related to age (P < 0.042), and health seeking behavior (P < 0.036). Staphylococcus aureus was the commonest causative organism. Seventy-seven percent (77%) underwent open arthrotomy. Anemia, septic shock, and joint stiffness were three top complications observed. Mortality rate was 2.3%, and cause of death was overwhelming sepsis. CONCLUSION In our setting, pyogenic septic arthritis is predominantly a childhood health problem and children under 5 years of age are the most vulnerable. Delayed presentation, an important factor in morbidity and mortality associated with septic arthritis was common among the patients, calls for a public enlightenment program on the importance of early presentation.
Collapse
Affiliation(s)
- Njoku Isaac Omoke
- Department of Surgery, Federal Teaching Hospital, Ebonyi State University, Abakaliki 480001, Nigeria
| | - Akputa Aja Obasi
- Department of Surgery, Federal Teaching Hospital, Ebonyi State University, Abakaliki 480001, Nigeria
| |
Collapse
|
14
|
Chiappini E, Mastrolia MV, Galli L, De Martino M, Lazzeri S. Septic arthritis in children in resource limited and non-resource limited countries: an update on diagnosis and treatment. Expert Rev Anti Infect Ther 2016; 14:1087-1096. [PMID: 27629150 DOI: 10.1080/14787210.2016.1235973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Septic arthritis (SA) is an orthopedic emergency in childhood. It is uncommon in high resource settings. However, an incidence of 5-20 per 100,000 children has been reported in low-income countries. Area covered: The predictive value of serum markers is still under debate and the proposed diagnostic algorithms for SA are not sufficiently validated in children. Recent data suggest that short-course intravenous treatment, followed by oral therapy, is as effective as traditional long-term treatment. Results from three randomized controlled trials suggest that the addition of systemic steroids may accelerate clinical improvement. Minimally invasive surgical techniques have been proposed for treatment in recent years. Expert commentary: The causes and the epidemiology of septic arthritis will continue to mutate according to the changes in immunization practices, bacterial resistance patterns and the implementation of PCR techniques. Future research should focus on the assessment of appropriate antibiotic regimens and surgical procedures.
Collapse
Affiliation(s)
- Elena Chiappini
- a Pediatric Infectious Disease Unit , Anna Meyer Children's University Hospital , Florence , Italy
| | - Maria Vincenza Mastrolia
- a Pediatric Infectious Disease Unit , Anna Meyer Children's University Hospital , Florence , Italy
| | - Luisa Galli
- a Pediatric Infectious Disease Unit , Anna Meyer Children's University Hospital , Florence , Italy
| | - Maurizio De Martino
- b Meyer Health Campus , Anna Meyer Children's University Hospital , Florence , Italy
| | - Simone Lazzeri
- c Orthopaedics and Traumatology Department , Anna Meyer Children's University Hospital , Florence , Italy
| |
Collapse
|
15
|
Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis. Int J Mol Sci 2016; 17:ijms17060855. [PMID: 27258258 PMCID: PMC4926389 DOI: 10.3390/ijms17060855] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 12/15/2022] Open
Abstract
Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.
Collapse
|
16
|
Arthroscopic Treatment of Septic Arthritis of the Elbow in a 4-Year-Old Girl. Case Rep Orthop 2015; 2015:853974. [PMID: 26713167 PMCID: PMC4680102 DOI: 10.1155/2015/853974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/23/2015] [Indexed: 11/25/2022] Open
Abstract
Pediatric septic arthritis is uncommon and has been traditionally treated by joint aspiration or open arthrotomy. There are some reports about arthroscopic surgery in pediatric septic arthritis of the knee, hip, and shoulder. However, there is no report for the case of elbow. We report a case of pediatric septic arthritis of elbow treated with arthroscopically with good clinical condition at 3-year follow-up. This paper is based on a report first published in Japanese (Tojo (2012)).
Collapse
|
17
|
Smith IDM, Winstanley JP, Milto KM, Doherty CJ, Czarniak E, Amyes SGB, Simpson AHRW, Hall AC. Rapid in situ chondrocyte death induced by Staphylococcus aureus toxins in a bovine cartilage explant model of septic arthritis. Osteoarthritis Cartilage 2013; 21:1755-65. [PMID: 23896315 DOI: 10.1016/j.joca.2013.07.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/29/2013] [Accepted: 07/17/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess in situ chondrocyte viability following exposure to a laboratory strain and clinical isolates of Staphylococcus aureus. METHODS Bovine cartilage explants were cultured in the presence of S. aureus 8325-4 (laboratory strain), clinical S. aureus isolates or non-infected culture medium of pH values 7.4, 6.4 and 5.4. All clinical isolates were isolated from the joint aspirates of patients presenting with S. aureus-induced septic arthritis (SA). At designated time points, in situ chondrocyte viability was assessed within defined regions-of-interest in the axial and coronal plane following live- and dead-cell image acquisition using the fluorescent probes 5-chloromethylfluorescein diacetate (CMFDA) and propidium iodide (PI), respectively, and confocal laser-scanning microscopy (CLSM). Cartilage water content, following S. aureus 8325-4 exposure, was obtained by measuring cartilage wet and dry weights. RESULTS S. aureus 8325-4 and clinical S. aureus isolates rapidly reduced in situ chondrocyte viability (>45% chondrocyte death at 40 h). The increased acidity, observed during bacterial culture, had a minimal effect on chondrocyte viability. Chondrocyte death commenced within the superficial zone (SZ) and rapidly progressed to the deep zone (DZ). Simultaneous exposure of SZ and DZ chondrocytes to S. aureus 8325-4 toxins found SZ chondrocytes to be more susceptible to the toxins than DZ chondrocytes. Cartilage water content was not significantly altered compared to non-infected controls. CONCLUSIONS Toxins released by S. aureus have a rapid and fatal action on in situ chondrocytes in this experimental model of SA. These data advocate the prompt and thorough removal of bacteria and their toxins during the treatment of SA.
Collapse
Affiliation(s)
- I D M Smith
- Centre for Integrative Physiology, The University of Edinburgh, Edinburgh, UK; Musculoskeletal Research Unit, Department of Orthopaedic and Trauma Surgery, The University of Edinburgh, Edinburgh, UK.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Stoesser N, Pocock J, Moore CE, Soeng S, Hor P, Sar P, Limmathurotsakul D, Day N, Kumar V, Khan S, Sar V, Parry CM. The epidemiology of pediatric bone and joint infections in Cambodia, 2007-11. J Trop Pediatr 2013; 59:36-42. [PMID: 22977206 PMCID: PMC3739458 DOI: 10.1093/tropej/fms044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
There are limited data on osteoarticular infections from resource-limited settings in Asia. A retrospective study of patients presenting to the Angkor Hospital for Children, Cambodia, January 2007-July 2011, identified 81 cases (28% monoarticular septic arthritis, 51% single-limb osteomyelitis and 15% multisite infections). The incidence was 13.8/100 000 hospital attendances. The median age was 7.3 years, with a male/female ratio of 1.9:1; 35% presented within 5 days of symptom onset (median 7 days). Staphylococcus aureus was cultured in 29 (36%) cases (52% of culture-positive cases); one isolate was methicillin-resistant (MRSA). Median duration of antimicrobial treatment was 29 days (interquartile range 21-43); rates of surgical intervention were 96%, and 46% of children had sequelae, with one fatality. In this setting osteoarticular infections are relatively common with high rates of surgical intervention and sequelae. Staphylococcus aureus is the commonest culturable cause, but methicillin-resistant S. aureus is not a major problem, unlike in other Asian centers.
Collapse
Affiliation(s)
| | - Joanna Pocock
- Wellcome Trust Major Overseas Program, Mahidol–Oxford Tropical Medicine Research Unit, Bangkok, Thailand,Department of Medicine, Addenbrooke’s Hospital, Cambridge, UK,University of Cambridge, Cambridge, UK
| | - Catrin E. Moore
- Angkor Hospital for Children, Siem Reap, Cambodia,Wellcome Trust Major Overseas Program, Mahidol–Oxford Tropical Medicine Research Unit, Bangkok, Thailand,Centrer for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford University, Oxford, UK
| | - Sona Soeng
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - PutChhat Hor
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Poda Sar
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Direk Limmathurotsakul
- Wellcome Trust Major Overseas Program, Mahidol–Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Nicholas Day
- Wellcome Trust Major Overseas Program, Mahidol–Oxford Tropical Medicine Research Unit, Bangkok, Thailand,Centrer for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford University, Oxford, UK
| | - Varun Kumar
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Sophy Khan
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Vuthy Sar
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Christopher M. Parry
- Angkor Hospital for Children, Siem Reap, Cambodia,Wellcome Trust Major Overseas Program, Mahidol–Oxford Tropical Medicine Research Unit, Bangkok, Thailand,Centrer for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford University, Oxford, UK
| |
Collapse
|
19
|
Mue D, Salihu M, Awonusi F, Yongu W, Kortor J, Elachi I. The epidemiology and outcome of acute septic arthritis: a hospital based study. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2013; 3:40-52. [PMID: 25453011 PMCID: PMC4228814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Septic arthritis is an acute bacterial infection affecting synovial joints. It is an orthopaedic emergency with potential high morbidity and mortality. This study determined the epidemiological pattern and outcome of acute septic arthritis and analyzed factors affecting morbidity and mortality Methods:This is a 5 year (2007-2012) retrospective study conducted at NKST rehabilitation hospital Mkar, North -Central Nigeria. All patients with septic arthritis upon presentation were consecutively selected. Patients with clear, non-purulent or haemorrhagic joint aspirate and those with incomplete data were excluded from the study. Data was analysed using SPSS version 21. RESULTS A total of 30 patients with 35septic joints were studied. Eighteen (60%) were males and 12(40%) were female with a male to female ratio of 1.5:1. Age range was 3months and 75years. The knee was the commonest 16(45.7 %) joint involved followed by the hip joint 11(31.4%). Staphylococcus aureus was the commonest organism cultured in joint aspirate in 19 (54.3%) patients and postoperative complications include joint stiffness 2(5.7%), painand stiffness 3(8.6%), bony ankylosis2(5.7%) and limb shortening 1(2.9%). CONCLUSION Early accurate diagnosis and prompt interventionare crucial for a successful outcome. Appropriate drainage of septic joints and antibiotic treatment can result in prompt recovery with minimum or no long term morbidity. Close follow-up is needed to monitor the growth of the affected limbs until skeletal maturity. There is a need to maintain a high index of suspicion and to educate patients about early presentation, early referral, avoidance of improper use of antibiotics and regular follow-up after the acute pathology.
Collapse
|
20
|
Chastel R, Pem R, Huard S, Hustachemathieu L, Hoen B, Garbuio P, Obert L. [Salmonella glenohumeral arthritis]. CHIRURGIE DE LA MAIN 2011; 30:413-416. [PMID: 22054812 DOI: 10.1016/j.main.2011.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 08/30/2011] [Accepted: 09/21/2011] [Indexed: 05/31/2023]
Abstract
We report the first case of glenohumeral Salmonella arthritis in an immunocompetent 86-year-old woman. There was no entry point. An empirical antibiotherapy was started then adapted according to culture results. Given the persistence of symptoms, an arthroscopy was performed at 72 hours for a joint lavage and synovectomy. Postoperative course was good. Apyrexia was obtained by 72 hours and inflammatory syndrome was normalized in 12 days. The patient was reviewed regularly until the 3rd month. She has no clinical sequelae. Her osteoarthritis remained stable throughout follow-up.
Collapse
Affiliation(s)
- R Chastel
- EA 4268 innovation, imagerie, ingénierie et intervention en santé « I4S - IFR 133 Inserm », pôle innovation et technique chirurgicale, service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU Jean-Minjoz, université de Franche-Comté, boulevard Fleming, Besançon, France.
| | | | | | | | | | | | | |
Collapse
|
21
|
Sultan J, Hughes PJ. Septic arthritis or transient synovitis of the hip in children. ACTA ACUST UNITED AC 2010; 92:1289-93. [PMID: 20798450 DOI: 10.1302/0301-620x.92b9.24286] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The crucial differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. In 1999, Kocher et al introduced four clinical predictors which were highly predictive (99.6%) of septic arthritis. These included fever (temperature ≥ 38.5°C), inability to bear weight, white blood-cell count > 12.0 × 109 cells/L and ESR ≥ 40 mm/hr; CRP ≥ 20 mg/L was later added as a fifth predictor. We retrospectively evaluated these predictors to differentiate septic arthritis from transient synovitis of the hip in children over a four-year period in a primary referral general hospital. When all five were positive, the predicted probability of septic arthritis in this study was only 59.9%, with fever being the best predictor. When applied to low-prevalence diseases, even highly specific tests yield a high number of false positives and the predictive value is thereby diminished. Clinical predictors should be applied with caution when assessing a child with an irritable hip, and a high index of suspicion, and close observation of patients at risk should be maintained.
Collapse
Affiliation(s)
- J. Sultan
- Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - P. J. Hughes
- Lancashire Teaching Hospitals, NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston PR2, 9HT, UK
| |
Collapse
|
22
|
Chimalizeni Y, Kawaza K, Molyneux E. The epidemiology and management of non typhoidal salmonella infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 659:33-46. [PMID: 20204753 DOI: 10.1007/978-1-4419-0981-7_3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
23
|
Native hip joint septic arthritis in 20 adults: Delayed presentation beyond three weeks predicts need for excision arthroplasty. J Infect 2008; 57:185-90. [DOI: 10.1016/j.jinf.2008.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 06/27/2008] [Accepted: 07/01/2008] [Indexed: 11/22/2022]
|