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G64(P) Kocher’s criteria: Is it always useful?
  1. MA Bacon1,
  2. HC Bailie2,
  3. KK Stohr3
  1. 1School of Clinical Medicine, University of Cambridge, Cambridge, UK
  2. 2Department of Paediatrics, Addenbrookes Hospital, Cambridge, UK
  3. 3Department of Orthopaedics, Addenbrookes Hospital, Cambridge, UK

Abstract

Background Kocher’s criteria help distinguish Septic Arthritis from Transient Synovitis. They are often extrapolated to support the diagnosis of other musculoskeletal infections but little of this appears in the literature. Factors that may affect whether paediatric musculoskeletal infections meet the criteria are the type of infection and the organism involved.

Aims To see, in paediatric musculoskeletal infection,

  • How many meet Kocher’s criteria

  • What C-Reactive Protein changes occur

  • What effect infection type and culpable organism had on meeting the criteria

Methods Retrospective documentation analysis was done on 80 Paediatric Musculoskeletal infections treated in Addenbrooke’s Hospital between 1st May 2013 and 12th September 2015. 5 patients were excluded due to inaccurate coding and documentation. Data was acquired through the EPIC computer system for patients treated after 26th October 2014. For those treated before this, the LARDR retrieval application was used. One of Kocher’s Criteria was not analysed due to insufficient documentation – the inability to weight-bear.

Results Analysis of how often Kocher’s Criteria were met is summarised in Figure 1. Data for individual factors is shown in Table 1. Figure 2 demonstrates the effects of infection type. 74% of patients had a C-Reactive Protein greater than 20 mg/L over the first 5 days of admission. Kingella was more likely to have a lower C-Reactive Protein than other organisms and was only diagnosed in the context of Septic Arthritis with Polymerase Chain Reaction. However, only 32% of cases with no growth had this done.

Abstract G64(P) Figure 1

Percentage of patients that met either nose, one, two or three of Kocher's Four Criteria

Abstract G64(P) Table 1

Show how many cases met Kocher’s thresholds for each criterion

Conclusions Kocher’s Criteria were seldom met amongst paediatric musculoskeletal patients. The least useful criterion was temperature. Criteria were met more often in Septic Arthritis than any other infection type highlighting its original use and the necessary wariness of its use in other musculoskeletal infections.

No organism was more likely to meet the criteria than another. Elevated C-Reactive Protein levels outperformed three of Kocher’s Criteria making it a useful adjunct.

Kingella did not meet Kocher’s Criteria less often but it produced lower C-Reactive Protein levels. Using Polymerase Chain Reaction to identify organisms is both clinically and financially beneficial. Our patients demonstrate particular usefulness in Kingella isolation.

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