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J Pediatr. 2014 Nov;165(5):985-9.e1. doi: 10.1016/j.jpeds.2014.07.060. Epub 2014 Sep 10.

Differentiating Kingella kingae septic arthritis of the hip from transient synovitis in young children.

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Clinical Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel.
Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Molecular Microbiology Department, University Hospital Sant Joan de Deu, Barcelona, Spain.
Pediatric Infectious Diseases Unit, Carmel Medical Center, and the Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.



To conduct a retrospective multicenter study to assess the ability of a predictive algorithm to differentiate between children with Kingella kingae infection of the hip and those with transient synovitis.


Medical charts of 25 Israeli and 9 Spanish children aged 6-27 months with culture-proven K kingae arthritis of the hip were reviewed, and information on the 4 variables included in the commonly used Kocher prediction algorithm (body temperature, refusal to bear weight, leukocytosis, and erythrocyte sedimentation rate) was gathered.


Patients with K kingae arthritis usually presented with mildly abnormal clinical picture and normal serum levels of or near-normal acute-phase reactants. Data on all 4 variables were available for 28 (82%) children, of whom 1 child had none, 6 children had 1, 13 children had 2, 5 had 3, and only 3 children had 4 predictors, implying ≤ 40% probability of infectious arthritis in 20 (71%) children.


Because of the overlapping features of K kingae arthritis of the hip and transient synovitis in children younger than 3 years of age, Kocher predictive algorithm is not sensitive enough for differentiating between these 2 conditions. To exclude K kingae arthritis, blood cultures and nucleic acid amplification assay should be performed in young children presenting with irritation of the hip, even in the absence of fever, leukocytosis, or a high Kocher score.

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