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DISTINGUISHING BETWEEN TRANSIENT SYNOVITIS AND SEPTIC ARTHRITIS IN THE LIMPING CHILD: HOW USEFUL ARE CLINICAL PREDICTION TOOLS?
A 3-year-old boy presents to the emergency department with a limp. He has been reluctant to weight bear on his right leg during the day and has a temperature of 37.9°C. Hip examination is painful. What clinical or laboratory tests could help discriminate between septic arthritis and transient synovitis?
Structured clinical question
In children [patient] presenting with acute hip pain, is there a single clinical or laboratory test [intervention] that will distinguish between septic arthritis and transient synovitis [outcome]?
Clinical bottom line
There is no one investigation or blood test that can distinguish between septic arthritis and transient synovitis. (Grade B)
There is no clinical prediction rule that has been validated by multi-centre prospective studies involving large patient numbers. (Grade B)
The combined presence of fever, non-weight bearing, C-reactive protein >20 or erythrocyte sedimentation rate >40, and a white cell count >12 is suspicious of septic arthritis. (Grade B)
Search strategy and outcome
Medline 1991–2007, using the PubMed interface. Search: “septic arthritis AND hip” resulted in …