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QUESTION 2
  1. H C Taekema,
  2. PR Landham,
  3. I Maconochie
  1. Department of Paediatrics, Royal United Hospital, Bath, UK; hestertaekema@doctors.org.uk
  2. Department of Orthopaedic Surgery, Musgrove Park Hospital, Taunton, UK
  3. Paediatric Emergency Department, St Mary’s Hospital, London, UK

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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 …

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