ESR in childhood septic arthritis
Date First Published:
September 9, 2000
Last Updated:
July 11, 2001
Report by:
Russel Boyd, Consultant in Emergency Medicine (MRI)
Search checked by:
Bruce Martin, MRI
Three-Part Question:
In [children presenting with acute hip pain] is [a raised ESR] useful in [diagnosing septic arthritis]?
Clinical Scenario:
A 3 year old child presents to the emergency department with a short history of limp, temperature and difficulty in weight bearing on the left leg. The pain is principally located at the hip joint and you fear this may be a septic arthritis. You wonder if an Erythrocyte Sedimentation Rate (ESR) will help in excluding the diagnosis of septic arthritis.
Search Strategy:
Medline 1966-12/00 using the OVID interface.
Search Details:
{[(exp child OR children.mp OR pediatrics OR paediatric.mp OR pediatric.mp) AND (exp hip OR exp hip joint OR hip.mp OR exp arthritis, infectious OR exp osteomyelitis OR septic arthritis.mp)] AND (exp laboratory techniques and procedures OR laboratory techniques.mp OR exp ultrasonography OR exp blood cell count OR exp c-reactive protein)} AND maximally sensitive diagnostic filter LIMIT to human and english.
Outcome:
334 papers found of which 329 were irrelevant or of insufficient quality. The remaining 5 papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Septic arthritis versus transient synovitis of the hip: the value of screening laboratory tests. Del Beccaro MA, Champoux AN, Bockers T et al. 1992, USA | 138 children age 2.5 weeks to 12 years admitted with acute hip pain | Diagnostic test study | Septic arthritis of the hip | Sensitivity 79% | Retrospective chart review including neonates. Gold standard not universally applied. |
| Raised ESR alone | Sensitivity 97% | ||||
| Raised ESR and temperature | |||||
| Management of irritable hip: a review of hospital admission policy. Taylor GR, Clarke NM. 1994, UK | 417 consecutive paediatric admissions with hip pain identified on retrospective chart review | Diagnostic test study | Septic arthritis of the hip | Sensitivity 90.5% | Diagnostic tests were not universally applied. Numbers do not appear to add up |
| Raised ESR alone | Sensitivity 97% | ||||
| Raised ESR and temperature or severe spasm/tenderness | |||||
| The irritable hip: immediate ultrasound guided aspiration and prevention of hospital admission. Fink AM, Berman L, Edwards D et al. 1995, England | 50 consecutive children age 1-10 years with acute hip pain | Diagnostic test study | Septic arthritis of the hip | Sensitivity 100% | Number too small to be meaningful. Only 1 case of septic arthritis found |
| Raised ESR alone | |||||
| The painful hip:evaluation of criteria for clinical decision making. Eich GF, Superti-Furga A, Umbricht FS et al. 1999, Switzerland | 114 children with acute hip pain | Diagnostic test study | Septic arthritis of the hip | Sensitivity not given | 14 patients excluded due to loss of data. Retrospective identification of cases. |
| Raised ESR alone | Sensitivity 100% | ||||
| Raised ESR and temperature or CRP | |||||
| Differentiating between septic Arthritis and transient synovitis of the hip in children. Kocher MS, Zurakowski D, Kasser JR. 1999, USA | 282 children with diagnosis of irritable hip | Diagnostic test study | Septic arthritis of the hip | Sensitivity not given | Cohort identified retrospectively |
| Raised ESR alone | Sensitivity 99.6% | ||||
| Raised ESR and temperature and WCC and inabilty to weight bear |
Author Commentary:
An isolated ESR is of variable sensitivity and not suitable to rule-out septic arthritis, however in combination with an elevated temperature and inability to weight bear or reduced mobility it becomes a useful rule-out tool with sensitivities consistently above 95%.
Bottom Line:
An isolated ESR test cannot exclude septic arthritis. In combination with temperature and ability to weight bear it can be used as a SnOut.
References:
- Del Beccaro MA, Champoux AN, Bockers T et al.. Septic arthritis versus transient synovitis of the hip: the value of screening laboratory tests.
- Taylor GR, Clarke NM.. Management of irritable hip: a review of hospital admission policy.
- Fink AM, Berman L, Edwards D et al.. The irritable hip: immediate ultrasound guided aspiration and prevention of hospital admission.
- Eich GF, Superti-Furga A, Umbricht FS et al.. The painful hip:evaluation of criteria for clinical decision making.
- Kocher MS, Zurakowski D, Kasser JR.. Differentiating between septic Arthritis and transient synovitis of the hip in children.