6305 Diagnosing bone and joint infection in young children: what is the role of clinical decision tools?

Résumé fourni par la source

Objectives Clinical decision aides (CDA) like Kocher or Caird criteria still form part of a clinical assessment of children presenting with suspected bone or joint infections but increasingly, imaging like ultrasound scan or MRI is becoming a routine part of the workup. Especially in younger children this may delay therapeutic intervention due to the need for sedation or a general anaesthetic (MRI). Younger children may also not exhibit non-weight bearing due to their developmental stage which is one of five diagnostic criteria. Our aim was to see whether there still is a role for using CDA, especially in a cohort of younger children where a modification of the assessment criterium non- weightbearing may be required. Methods Retrospective data analysis of patients with a diagnosis of septic arthritis and/or osteomyelitis in a tertiary paediatric centre using the electronic patient record system EPIC, admitted between 10thMarch, 2015 and 10thApril, 2023. Patients were ranked according to age on presentation and the youngest 100 were included in this study. Data was collected for CDA criteria with ‘non-weightbearing’ being replaced by ‘non-use of extremity’. Results Forty-eight patients were aged less than two years (age range 13 days to 14 years). Clinical criteria matched those of Caird (2006)1 well (figure 1) with the exception of ESR which is more challenging to obtain in young children. This applied to the whole cohort and the children aged under 2 years. Only four percent in our cohort scored only one criterium, putting their risk of infection at 36.7%, 16 percent of our patients had 2 criteria (risk 62.4%) and the rest had 3 criteria or more (risk in excess of 82.6%). Conclusion There still is a role for the use of CDA in children presenting with suspected bone or joint infection. Rather than replacing imaging or microbiological sampling in order to establish a definitive diagnosis, the role of using a CDA lies in prioritising diagnostic and therapeutic interventions in children at high risk of infection rather than delaying treatment for the availability of a general anaesthetic. In small children, the criterium of ‘non-weightbearing’ should be replaced with ‘non-use of extremity’. A prospective review of these criteria in a population of young children is required to confirm our findings. Reference Michelle S Caird. The Journal of Bone & Joint Surgery June 2006.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.