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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.

Author information

1
Clinical Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel.
2
Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
3
Molecular Microbiology Department, University Hospital Sant Joan de Deu, Barcelona, Spain.
4
Pediatric Infectious Diseases Unit, Carmel Medical Center, and the Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Abstract

OBJECTIVE:

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.

STUDY DESIGN:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
25217199
DOI:
10.1016/j.jpeds.2014.07.060
[Indexed for MEDLINE]

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