Clinical Orthopaedics and Related Research®

, Volume 468, Issue 3, pp 861–866 | Cite as

Sensitivity of Erythrocyte Sedimentation Rate and C-reactive Protein in Childhood Bone and Joint Infections

  • Markus PääkkönenEmail author
  • Markku J. T. Kallio
  • Pentti E. Kallio
  • Heikki Peltola
Original Article


In addition to the examination of clinical signs, several laboratory markers have been measured for diagnostics and monitoring of pediatric septic bone and joint infections. Traditionally erythrocyte sedimentation rate (ESR) and leukocyte cell count have been used, whereas C-reactive protein (CRP) has gained in popularity. We monitored 265 children at ages 3 months to 15 years with culture-positive osteoarticular infections with a predetermined series of ESR, CRP, and leukocyte count measurements. On admission, ESR exceeded 20 mm/hour in 94% and CRP exceeded 20 mg/L in 95% of the cases, the mean (± standard error of the mean) being 51 ± 2 mm/hour and 87 ± 4 mg/L, respectively. ESR normalized in 24 days and CRP in 10 days. Elevated CRP gave a slightly better sensitivity in diagnostics than ESR, but best sensitivity was gained with the combined use of ESR and CRP (98%). Elevated ESR or CRP was seen in all cases during the first 3 days. Measuring ESR and CRP on admission can help the clinician rule out an acute osteoarticular infection. CRP normalizes faster than ESR, providing a clear advantage in monitoring recovery.

Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.


Erythrocyte Sedimentation Rate Septic Arthritis Joint Infection Juvenile Rheumatoid Arthritis Reactive Arthritis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank the following physicians for their participation in the OM-SA Study Group: Kari Aalto, Aurora Hospital, and Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland; Ilkka Anttolainen, Päijät-Häme Central Hospital, Lahti, Finland; Marja Heikkinen, Kuopio University Hospital, Kuopio, Finland; Anita Hiippala, Etelä-Saimaa Central Hospital, Lappeenranta, Finland; Ulla Kaski, Seinäjoki Central Hospital, Seinäjoki, Finland; Niilo Kojo, Etelä-Saimaa Central Hospital, Lappeenranta, Finland; Pentti Lautala, Päijät-Häme Central Hospital, Lahti, Finland; Juhani Merikanto, Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland; Pekka Ojajärvi, Jorvi Hospital, Espoo, Finland; Eeva Salo, Aurora Hospital, and Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland.


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Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Markus Pääkkönen
    • 1
    • 2
    Email author
  • Markku J. T. Kallio
    • 1
  • Pentti E. Kallio
    • 1
  • Heikki Peltola
    • 1
  1. 1.Helsinki University Central Hospital, Hospital for Children and AdolescentsHelsinkiFinland
  2. 2.Mikkeli Central HospitalMikkeliFinland

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