Identifying Predictive Factors of Pediatric Septic Arthritis of the Knee in a Lyme Endemic Area.
BACKGROUND: Septic arthritis of the knee in the pediatric patient is a diagnosis that requires prompt identification and treatment. The purpose of this study was to identify clinical and laboratory parameters that allow differential diagnosis of septic arthritis from non-septic arthritis in children. METHODS: Fifty-four pediatric patients with atraumatic isolated knee pain were retrospectively identified at three institutions and diagnosed with septic arthritis (SA, N = 28), Lyme arthritis (LA, N = 11), or transient synovitis (TS, N = 15). Clinical and laboratory data were analyzed to identify which factors were most predictive of SA of the knee. RESULTS: Fever at time of presentation, a negative anti-streptolysin-O (ASO), erythrocyte sedimentation rate (ESR) > 40 mm/hr, and C-reactive protein (CRP) > 20 mg/L were the most predictive factors for distinguishing between septic arthritis (SA) and non-septic arthritis (transient synovitis or Lyme arthritis). Elevated ESR and CRP were both significantly higher in patients with SA when compared to TS or LA. CONCLUSION: When evaluating children with atraumatic isolated knee pain, a combination of the above factors should be utilized when ruling out septic arthritis.
Gage, MJ; Twomey, KD; Sala, DA; Maguire, KJ; Hanstein, R; Hennrikus, WL; Otsuka, NY
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