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Daniel C Perry - One of the best experts on this subject based on the ideXlab platform.
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the epidemiology of Transient Synovitis in liverpool uk
Journal of Children's Orthopaedics, 2014Co-Authors: William D Harrison, C. E. Bruce, R Singhal, Daniel C Perry, A K VooghtAbstract:Abstract Background The epidemiology of Transient Synovitis is poorly understood, and the aetiology is unknown, although a suggestion of a viral association predominates. Purpose This population-based study investigated the epidemiology in order to formulate aetiological theories of pathogenesis. Patient and methods Cases in Merseyside were identified between 2004 and 2009. Incidence rates were determined and analysed by age, sex, season and region of residence. Socioeconomic deprivation scores were generated using the Index of Multiple Deprivation, allocated by postcode. Poisson confidence intervals were calculated and Poisson regression was used to check for trends. Results Two hundred and fifty-nine cases were identified over 5.5 years. The annual incidence was 25.1 (95 % CI 22.1–28.5) per 100,000 0–14 year-olds. Male to female ratio was 3.2:1 (p < 0.001). Mean age at presentation was 5.4 years (95 % CI 5.0–5.8), which demonstrated a near-normal distribution. No relationship was identified between seas...
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the use of crp within a clinical prediction algorithm for the differentiation of septic arthritis and Transient Synovitis
Orthopaedic Proceedings, 2012Co-Authors: R Singhal, F. N. Khan, D. Cohen, H. L. Stevenson, L. A. James, J. S. Sampath, Daniel C Perry, C. E. BruceAbstract:Background Establishing the diagnosis in a child presenting with an atraumatic limp can be difficult. Clinical prediction algorithms have been devised to distinguish septic arthritis (SA) from Transient Synovitis (TS). Within Europe measurement of the Erythrocyte Sedimentation Rate (ESR) has largely been replaced with assessment of C-Reactive Protein (CRP) as an acute phase protein. We produce a prediction algorithm to determine the significance of CRP in distinguishing between TS and SA. Method All children with a presentation of ‘atraumatic limp’ and a proven effusion on hip ultrasound between 2004 and 2009 were included. Patient demographics, details of the clinical presentation and laboratory investigations were documented to identify a response to each of the four variables (Weight bearing status, WCC >12,000 cells/m3, CRP >20mg/L and Temperature >38.5°C). SA was defined based upon culture and microscopy of the operative findings. Results 311 hips were included within the study. Of these 282 were considered to have Transient Synovitis. 29 patients met criteria to be classified as SA based upon laboratory assessment of the synovial fluid. The introduction of CRP eliminated the need for a four variable model as the use of two variables (CRP and weight bearing status) had similar efficacy. Treating individuals who were non-weight-bearing and a CRP >20mg/L as SA correctly classified 94.8% individuals, with a sensitivity of 75.9%, specificity of 96.8%, positive predictive value of 71.0%, and negative predictive value of 97.5%. CRP was a significant independent predictor of septic arthritis. Conclusions CRP was a strong independent risk factor of septic arthritis, and its inclusion within a regression model simplifies the diagnostic algorithm. Nevertheless, this and other models are generally more reliable in excluding SA, than confirming SA, and therefore a clinician9s acumen remains important in identifying SA in those individuals with a single abnormal variable.
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septic arthritis vs Transient Synovitis in children a tertiary health care centre study
Orthopaedic Proceedings, 2012Co-Authors: R Singhal, F. N. Khan, D. Cohen, H. L. Stevenson, L. A. James, J. S. Sampath, Daniel C Perry, C. E. BruceAbstract:Background Establishing the diagnosis in a child presenting with an atraumatic limp can be challenging. There is particular difficulty distinguishing septic arthritis (SA) from Transient Synovitis (TS) and consequently clinical prediction algorithms have been devised to differentiate the conditions using the presence of fever, raised erythrocyte sedimentation rate (ESR), raised white cell count (WCC) and inability to weight bear. Within Europe measurement of the ESR has largely been replaced with assessment of C-reactive protein (CRP) as an acute phase protein. We have evaluated the utility of including CRP in a clinical prediction algorithm to distinguish TS from SA. Method All children with a presentation of ‘atraumatic limp’ and a proven effusion on hip ultrasound between 2004 and 2009 were included. Patient demographics, details of the clinical presentation and laboratory investigations were documented to identify a response to each of four variables (Weight bearing status, WCC >12,000 cells/m3, CRP >20mg/L and Temperature >38.5 degrees C. The definition of SA was based upon microscopy and culture of the joint fluid collected at arthrotomy. Results 311 hips were included within the study. Of these 282 were considered to have Transient Synovitis. 29 patients met criteria to be classified as SA based upon laboratory assessment of the synovial fluid. The introduction of CRP eliminated the need for a four variable model as the use of two variables (CRP and weight bearing status) had similar efficacy. An algorithm that indicated a diagnosis of SA in individuals who could not weight-bear and who had a CRP >20mg/L correctly classified SA in 94.8% individuals, with a sensitivity of 75.9%, specificity of 96.8%, positive predictive value of 71.0%, and negative predictive value of 97.5%. CRP was a significant independent predictor of septic arthritis. Conclusions CRP was a strong independent risk factor of septic arthritis, and its inclusion within a regression model simplifies the diagnostic algorithm, such that a two-variable model correctly classified 95% individuals with SA. Nevertheless, this and similar algorithms are generally more reliable in excluding SA, than confirming SA, and therefore a clinician9s acumen remains important in identifying SA in those individuals with a single abnormal variable.
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the use of crp within a clinical prediction algorithm for the differentiation of septic arthritis and Transient Synovitis in children
Journal of Bone and Joint Surgery-british Volume, 2011Co-Authors: R Singhal, F. N. Khan, D. Cohen, H. L. Stevenson, L. A. James, J. S. Sampath, Daniel C Perry, C. E. BruceAbstract:Clinical prediction algorithms are used to differentiate Transient Synovitis from septic arthritis. These algorithms typically include the erythrocyte sedimentation rate (ESR), although in clinical practice measurement of the C-reactive protein (CRP) has largely replaced the ESR. We evaluated the use of CRP in a predictive algorithm. The records of 311 children with an effusion of the hip, which was confirmed on ultrasound, were reviewed (mean age 5.3 years (0.2 to 15.1)). Of these, 269 resolved without intervention and without long-term sequelae and were considered to have had Transient Synovitis. The remaining 42 underwent arthrotomy because of suspicion of septic arthritis. Infection was confirmed in 29 (18 had micro-organisms isolated and 11 had a high synovial fluid white cell count). In the remaining 13 no evidence of infection was found and they were also considered to have had Transient Synovitis. In total 29 hips were categorised as septic arthritis and 282 as Transient Synovitis. The temperature, weight-bearing status, peripheral white blood cell count and CRP was reviewed in each patient. A CRP > 20 mg/l was the strongest independent risk factor for septic arthritis (odds ratio 81.9, p 20 mg/l) were independent in differentiating septic arthritis from Transient Synovitis. Individuals with neither predictor had a < 1% probability of septic arthritis, but those with both had a 74% probability of septic arthritis. A two-variable algorithm can therefore quantify the risk of septic arthritis, and is an excellent negative predictor.
Pablo Yagupsky - One of the best experts on this subject based on the ideXlab platform.
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differentiating kingella kingae septic arthritis of the hip from Transient Synovitis in young children
The Journal of Pediatrics, 2014Co-Authors: Pablo Yagupsky, Gal Dubnovraz, Amadeu Gene, Moshe EphrosAbstract:Objective To conduct a retrospective multicenter study to assess the ability of a predictive algorithm to differentiate between children with Kingella kingae infection of the hip and those with Transient Synovitis. Study design Medical charts of 25 Israeli and 9 Spanish children aged 6-27 months with culture-proven K kingae arthritis of the hip were reviewed, and information on the 4 variables included in the commonly used Kocher prediction algorithm (body temperature, refusal to bear weight, leukocytosis, and erythrocyte sedimentation rate) was gathered. Results Patients with K kingae arthritis usually presented with mildly abnormal clinical picture and normal serum levels of or near-normal acute-phase reactants. Data on all 4 variables were available for 28 (82%) children, of whom 1 child had none, 6 children had 1, 13 children had 2, 5 had 3, and only 3 children had 4 predictors, implying ≤40% probability of infectious arthritis in 20 (71%) children. Conclusions Because of the overlapping features of K kingae arthritis of the hip and Transient Synovitis in children younger than 3 years of age, Kocher predictive algorithm is not sensitive enough for differentiating between these 2 conditions. To exclude K kingae arthritis, blood cultures and nucleic acid amplification assay should be performed in young children presenting with irritation of the hip, even in the absence of fever, leukocytosis, or a high Kocher score.
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differentiation between septic arthritis and Transient Synovitis of the hip in children
Journal of Bone and Joint Surgery American Volume, 2005Co-Authors: Pablo YagupskyAbstract:To The Editor: I read with interest the article “Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children with Clinical Prediction Algorithms” (2004;86:956-62), by Luhmann et al., in which the distribution of a variety of demographic, clinical, and laboratory parameters in children with septic arthritis or Transient Synovitis of the hip was compared. The authors found that the two populations differed in terms of history of fever, erythrocyte sedimentation rate values, white blood-cell count in the synovial fluid, and cellular composition of the peripheral blood and joint fluid leukocytes. Of the forty-seven children included in the group with composite septic arthritis, twenty had either a positive synovial fluid culture or a positive blood culture and a synovial fluid white blood-cell count of ≥50 × 109/L (“true septic arthritis”) and twenty-seven had negative blood or synovial fluid cultures and a synovial fluid white blood-cell count of ≥50 × 109/L (“presumed septic arthritis”). Although no explicit criteria for defining a positive bacteriological culture were stated in the Materials … Corresponding author: Scott J. Luhmann, MD St. Louis Children's Hospital One Children's Place Suite 4S20 St. Louis, MO 63110 luhmanns{at}msnotes.wustl.edu
Kyusung Kwack - One of the best experts on this subject based on the ideXlab platform.
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usefulness of dynamic contrast enhanced mri in differentiating between septic arthritis and Transient Synovitis in the hip joint
American Journal of Roentgenology, 2012Co-Authors: Eun Young Kim, Kyusung Kwack, Jae Ho Cho, Doohyung Lee, Seunghyun YoonAbstract:OBJECTIVE. The purpose of this study was to show the usefulness of dynamic contrast-enhanced MRI (DCE-MRI) and to determine the optimal time window in MRI for differentiating between septic arthritis and Transient Synovitis in painful hip joints. MATERIALS AND METHODS. Eighteen patients who underwent DCE-MRI were enrolled, and the final diagnoses were septic arthritis (n = 7) and Transient Synovitis (n = 11). The enhancement patterns of DCE-MRI were dichotomized according to the shape of the time–signal intensity curves. The time at the maximal difference in the signal intensity between two time–signal intensity curves of both femoral heads was recorded. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Receiver operating characteristic curves were calculated. RESULTS. Six of seven patients with septic arthritis in the hip joint had decreased enhancement during the early phase of DCE-MRI. The enhancement difference between the two patient groups ...
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septic arthritis versus Transient Synovitis of the hip gadolinium enhanced mri finding of decreased perfusion at the femoral epiphysis
American Journal of Roentgenology, 2007Co-Authors: Kyusung Kwack, Jae Hyun Cho, Jei Hee Lee, Jae Ho Cho, Sun Yong KimAbstract:OBJECTIVE. The purpose of this study was to identify differences in the MRI findings of septic arthritis and Transient Synovitis in patients with nontraumatic acute hip pain and hip effusion.MATERIALS AND METHODS. The MRI findings in nine patients with septic arthritis and 11 with Transient Synovitis were reviewed retrospectively. This study was approved by our institutional review board. The diagnoses were based on findings at physical examination, laboratory studies, and joint aspiration and bacteriologic study. The MRI findings were analyzed with emphasis on the grade of joint effusion, alterations in signal intensity in the soft tissues and bone marrow, and the presence of decreased perfusion at the femoral head.RESULTS. Low signal intensity on fat-suppressed gadolinium-enhanced T1-weighted coronal MRI suggesting decreased perfusion at the femoral head of the affected hip joint was seen in eight of nine patients with septic arthritis and in two of 11 patients with Transient Synovitis. Statistically re...
C. E. Bruce - One of the best experts on this subject based on the ideXlab platform.
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Orthopaedic Surgeon
2016Co-Authors: F. N. Khan, D. Cohen, H. L. Stevenson, L. A. James, J. S. Sampath, C. E. Bruce, D. C. PerryAbstract:The use of CRP within a clinical prediction algorithm for the differentiation of septic arthritis and Transient Synovitis in children R. Singhal, D. C. Perry
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the epidemiology of Transient Synovitis in liverpool uk
Journal of Children's Orthopaedics, 2014Co-Authors: William D Harrison, C. E. Bruce, R Singhal, Daniel C Perry, A K VooghtAbstract:Abstract Background The epidemiology of Transient Synovitis is poorly understood, and the aetiology is unknown, although a suggestion of a viral association predominates. Purpose This population-based study investigated the epidemiology in order to formulate aetiological theories of pathogenesis. Patient and methods Cases in Merseyside were identified between 2004 and 2009. Incidence rates were determined and analysed by age, sex, season and region of residence. Socioeconomic deprivation scores were generated using the Index of Multiple Deprivation, allocated by postcode. Poisson confidence intervals were calculated and Poisson regression was used to check for trends. Results Two hundred and fifty-nine cases were identified over 5.5 years. The annual incidence was 25.1 (95 % CI 22.1–28.5) per 100,000 0–14 year-olds. Male to female ratio was 3.2:1 (p < 0.001). Mean age at presentation was 5.4 years (95 % CI 5.0–5.8), which demonstrated a near-normal distribution. No relationship was identified between seas...
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the use of crp within a clinical prediction algorithm for the differentiation of septic arthritis and Transient Synovitis
Orthopaedic Proceedings, 2012Co-Authors: R Singhal, F. N. Khan, D. Cohen, H. L. Stevenson, L. A. James, J. S. Sampath, Daniel C Perry, C. E. BruceAbstract:Background Establishing the diagnosis in a child presenting with an atraumatic limp can be difficult. Clinical prediction algorithms have been devised to distinguish septic arthritis (SA) from Transient Synovitis (TS). Within Europe measurement of the Erythrocyte Sedimentation Rate (ESR) has largely been replaced with assessment of C-Reactive Protein (CRP) as an acute phase protein. We produce a prediction algorithm to determine the significance of CRP in distinguishing between TS and SA. Method All children with a presentation of ‘atraumatic limp’ and a proven effusion on hip ultrasound between 2004 and 2009 were included. Patient demographics, details of the clinical presentation and laboratory investigations were documented to identify a response to each of the four variables (Weight bearing status, WCC >12,000 cells/m3, CRP >20mg/L and Temperature >38.5°C). SA was defined based upon culture and microscopy of the operative findings. Results 311 hips were included within the study. Of these 282 were considered to have Transient Synovitis. 29 patients met criteria to be classified as SA based upon laboratory assessment of the synovial fluid. The introduction of CRP eliminated the need for a four variable model as the use of two variables (CRP and weight bearing status) had similar efficacy. Treating individuals who were non-weight-bearing and a CRP >20mg/L as SA correctly classified 94.8% individuals, with a sensitivity of 75.9%, specificity of 96.8%, positive predictive value of 71.0%, and negative predictive value of 97.5%. CRP was a significant independent predictor of septic arthritis. Conclusions CRP was a strong independent risk factor of septic arthritis, and its inclusion within a regression model simplifies the diagnostic algorithm. Nevertheless, this and other models are generally more reliable in excluding SA, than confirming SA, and therefore a clinician9s acumen remains important in identifying SA in those individuals with a single abnormal variable.
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septic arthritis vs Transient Synovitis in children a tertiary health care centre study
Orthopaedic Proceedings, 2012Co-Authors: R Singhal, F. N. Khan, D. Cohen, H. L. Stevenson, L. A. James, J. S. Sampath, Daniel C Perry, C. E. BruceAbstract:Background Establishing the diagnosis in a child presenting with an atraumatic limp can be challenging. There is particular difficulty distinguishing septic arthritis (SA) from Transient Synovitis (TS) and consequently clinical prediction algorithms have been devised to differentiate the conditions using the presence of fever, raised erythrocyte sedimentation rate (ESR), raised white cell count (WCC) and inability to weight bear. Within Europe measurement of the ESR has largely been replaced with assessment of C-reactive protein (CRP) as an acute phase protein. We have evaluated the utility of including CRP in a clinical prediction algorithm to distinguish TS from SA. Method All children with a presentation of ‘atraumatic limp’ and a proven effusion on hip ultrasound between 2004 and 2009 were included. Patient demographics, details of the clinical presentation and laboratory investigations were documented to identify a response to each of four variables (Weight bearing status, WCC >12,000 cells/m3, CRP >20mg/L and Temperature >38.5 degrees C. The definition of SA was based upon microscopy and culture of the joint fluid collected at arthrotomy. Results 311 hips were included within the study. Of these 282 were considered to have Transient Synovitis. 29 patients met criteria to be classified as SA based upon laboratory assessment of the synovial fluid. The introduction of CRP eliminated the need for a four variable model as the use of two variables (CRP and weight bearing status) had similar efficacy. An algorithm that indicated a diagnosis of SA in individuals who could not weight-bear and who had a CRP >20mg/L correctly classified SA in 94.8% individuals, with a sensitivity of 75.9%, specificity of 96.8%, positive predictive value of 71.0%, and negative predictive value of 97.5%. CRP was a significant independent predictor of septic arthritis. Conclusions CRP was a strong independent risk factor of septic arthritis, and its inclusion within a regression model simplifies the diagnostic algorithm, such that a two-variable model correctly classified 95% individuals with SA. Nevertheless, this and similar algorithms are generally more reliable in excluding SA, than confirming SA, and therefore a clinician9s acumen remains important in identifying SA in those individuals with a single abnormal variable.
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the use of crp within a clinical prediction algorithm for the differentiation of septic arthritis and Transient Synovitis in children
Journal of Bone and Joint Surgery-british Volume, 2011Co-Authors: R Singhal, F. N. Khan, D. Cohen, H. L. Stevenson, L. A. James, J. S. Sampath, Daniel C Perry, C. E. BruceAbstract:Clinical prediction algorithms are used to differentiate Transient Synovitis from septic arthritis. These algorithms typically include the erythrocyte sedimentation rate (ESR), although in clinical practice measurement of the C-reactive protein (CRP) has largely replaced the ESR. We evaluated the use of CRP in a predictive algorithm. The records of 311 children with an effusion of the hip, which was confirmed on ultrasound, were reviewed (mean age 5.3 years (0.2 to 15.1)). Of these, 269 resolved without intervention and without long-term sequelae and were considered to have had Transient Synovitis. The remaining 42 underwent arthrotomy because of suspicion of septic arthritis. Infection was confirmed in 29 (18 had micro-organisms isolated and 11 had a high synovial fluid white cell count). In the remaining 13 no evidence of infection was found and they were also considered to have had Transient Synovitis. In total 29 hips were categorised as septic arthritis and 282 as Transient Synovitis. The temperature, weight-bearing status, peripheral white blood cell count and CRP was reviewed in each patient. A CRP > 20 mg/l was the strongest independent risk factor for septic arthritis (odds ratio 81.9, p 20 mg/l) were independent in differentiating septic arthritis from Transient Synovitis. Individuals with neither predictor had a < 1% probability of septic arthritis, but those with both had a 74% probability of septic arthritis. A two-variable algorithm can therefore quantify the risk of septic arthritis, and is an excellent negative predictor.
Paul M Mendelman - One of the best experts on this subject based on the ideXlab platform.
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septic arthritis versus Transient Synovitis of the hip the value of screening laboratory tests
Annals of Emergency Medicine, 1992Co-Authors: Mark A Del Beccaro, Ann N Champoux, Tobias M Bockers, Paul M MendelmanAbstract:Study objective: To determine the diagnostic value of screening laboratory and initial body temperature data in differentiating septic arthritis of the hip from Transient Synovitis of the hip in children who present to the emergency department with a complaint of hip pain. Design: Retrospective review of cases of septic arthritis of the hip and Transient Synovitis of the hip in a 1:2.5 ratio. Setting: An urban regional children's hospital with 20,000 annual ED visits. Results: Ninety-four children with Transient Synovitis of the hip and 38 children with septic arthritis of the hip were identified. The children with septic arthritis of the hip had a significantly higher initial temperature (38.1 C versus 37.2 C, P = .000014), mean erythrocyte sedimentation rate (44 mm/hr versus 19 mm/hr, P = .000001), and mean WBC count (13,200/mm 3 versus 11,200/mm 3 , P = .02). However, the degree of overlap in these variables was large. The combination of an erythrocyte sedimentation rate of more than 20 mm/hr and/or a temperature of more than 37.5 C identified 97% of all cases of septic arthritis of the hip. Conclusion: There is clinically significant overlap in the erythrocyte sedimentation rate, temperature, and WBC count in children with septic arthritis of the hip versus Transient Synovitis of the hip. All children with an irritable hip without a clearly identified source who have an erythrocyte sedimentation rate of more than 20 mm/hr or a temperature of more than 37.5 C should be considered for diagnostic hip aspiration.