Title: Septic Arthritis in Children<br/>Author: Brian Corwell<br/><a href='http://umem.org/profiles/faculty/294/'>[Click to email author]</a><hr/><p>
Septic Arthritis in Children</p>
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Classic presentation: Pain, fever (may not always be present)</p>
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Limited range of motion of joint or refusal to bear weight,</p>
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Joint swelling (difficult to visualize in hip or shoulder),</p>
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Limb held in position that allows greatest capsular volume (elbow held in 30° flexion for example)</p>
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Diagnostic testing may include diagnostic markers (ESR, CRP) or imaging (US/MRI)</p>
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Most common organisms: Staph and Strep, Neisseria (adolescents), HACEK organisms, consider gram negatives in immunocompromised children</p>
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DDX: Transient synovitis, osteonercrosis or osteomyelitis, Psoas abscess, acute leukemia, Lyme disease</p>
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A common ED presentation is the child with the painful limp</p>
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35% of all cases of septic arthritis</p>
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>50% of cases occur in children younger than 2yo</p>
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Hip held in flexion, Abduction, external rotation</p>
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Fever and inflammatory markers are more sensitive than WBC count and refusal to bear weight</p>
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<strong>Kocher criteria:</strong></p>
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1) Refusal to weight bear on affected side</p>
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2) Sed rate greater than 40mm/hr</p>
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3) Fever (>38.5°C</p>
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4) WBC count of >12,000 mm3</p>
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</p>
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IF<br />
- 4/4 criteria are met, there is a 99.6% chance of septic arthritis; <br />
- when 3/4 criteria are met, there is a 93% chance of septic arthritis; <br />
- when 2/4 criteria are met, there is a 40% chance of septic arthritis; <br />
- when 1/4 criteria are met, there is a 3% chance of septic arthritis; </p>
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CRP can also be incorporated into a diagnostic algorithm</p>
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CRP>2.0 (mg/dl) in a child who refuses to bear weight yields a 74% probability of septic arthritis</p>
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<fieldset><legend>References</legend>
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https://www.ncbi.nlm.nih.gov/pubmed/10608376</p>
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