Abstract
Purpose
Differentiating septic arthritis (SA) from transient synovitis (TS) in children remains a diagnostic challenge. Several algorithms have been developed to diagnose SA including Kocher’s criteria and its subsequent modifications, but reports show variable efficacy. This study aims to examine the diagnostic utility of a novel method only using C-reactive protein (CRP) and ultrasound (US) findings of effusion in differentiating SA from TS, determine the optimal values for these predictors and validate this method against existing clinical predictors.
Methods
A 5-year retrospective study was performed including all paediatric patients with acute, non-traumatic hip pain with a suspicion of SA. All patients were evaluated using Kocher’s criteria, Caird’s criteria, and the novel method. Multivariate logistic regression was performed to identify independent clinical predictors of SA. The degree of agreement between the various methods were assessed using Cohen’s kappa (k). Receiver operating characteristics (ROC) curves were used to examine the diagnostic accuracy of this novel method as well as to determine optimal cut-offs for US effusion and CRP in diagnosing SA.
Results
Hundred and one patients were recruited. CRP and effusion on US were found to be independent predictors of SA. Both Kocher’s and Caird’s method showed good specificity (98.9%) but extremely poor sensitivity for SA (0%). When Kocher’s four clinical predictors were present, probability of SA was only 59.16%. The k for both Kocher’s and Caird’s methods, was -0.017 indicating poor agreement. However the k in the novel method was 0.641, indicating good agreement.
Conclusion
Our study showed that the novel method using CRP (≥ 20 mg/L) and US finding of effusion (≥ 7 mm) has a high specificity (97%) and sensitivity (71%) in diagnosing SA.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by RAO, DWRS, AS and KPLW. The first draft of the manuscript was written by RAO and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Singhealth Centralised Institutional Ethics Review Board.
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As all data had been anonymised, no consent to participate or to publish were taken. This was also waived by our local ethics board.
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Olandres, R.A., Seng, D.W.R., Seneviratna, A. et al. C-reactive protein of ≥ 20 mg/L and ultrasound finding of an effusion ≥ 7 mm has a high specificity and sensitivity in diagnosing paediatric hip septic arthritis. Arch Orthop Trauma Surg 143, 7027–7033 (2023). https://doi.org/10.1007/s00402-023-05005-7
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DOI: https://doi.org/10.1007/s00402-023-05005-7