Kocher Criteria for Septic Arthritis
Septic arthritis vs transient synovitis in pediatric inflamed hip.
id
1817
full_title
Kocher Criteria for Septic Arthritis
short_title
Kocher Criteria
med_description
Distinguishes septic arthritis from transient synovitis in a child with an inflamed hip.
description
The Kocher Criteria for Septic Arthritis distinguishes septic arthritis from transient synovitis in a child with an inflamed hip.
keywords
Kocher Criteria, kocher hip, septic arthritis criteria, child hip criteria, pediatric spetic joint, septic joint criteria, hip sepsis score, kocher calc.
complaint
[ "Extremity Pain", "Fever", "Joint Pain" ]
formula
Series of Yes/No questions, each “Yes” increases the risk likelihood of septic arthritis.
evidence
Original derivation study published in 1999
- Retrospective chart review of 282 patients who were evaluated between 1979 and 1996 for an acutely irritable hip for which the differential diagnosis included transient synovitis and septic arthritis.
- Septic arthritis diagnosed with positive joint fluid culture or > 50,000 WBCs/mm3 in joint fluid.
- 82 patients were diagnosed with septic arthritis while 86 were diagnosed with transient synovitis (<50,000 WBCs/mm3 with negative joint fluid culture and resolution of symptoms without antimicrobial therapy).
- Found four independent multivariate predictors for differentiation between septic arthritis and transient synovitis: history of fever, non-weight-bearing, ESR > 40 mm/hour, serum WBC > 12,000.
- Probability for septic arthritis based on number of predictors. Zero predictors: < 0.2% risk, 1 predictor: 3.0%, 2 predictors: 40%, 3 predictors: 93.1%, 4 predictors: 99.6%.
- Criteria was prospectively applied to patients presenting to a major tertiary-care children’s hospital between 1997 and 2002 with an acutely irritable hip.
- Included 213 consecutive patients, 51 were diagnosed with septic arthritis and 103 were diagnosed with transient synovitis.
- Probability for septic arthritis based on number of predictors. Zero predictors: 2.0% risk, 1 predictor: 9.5%, 2 predictors: 35.0%, 3 predictors: 72.8%, 4 predictors: 93.0%.
Other studies
- Outside group retrospectively applied the Kocher criteria to their population and found that having all four predictors yielded a probability for septic arthritis of just 59%.
- Did not publish its rate of septic arthritis when no predictors were present.
- Another group did the same retrospective application of the Kocher criteria and found a predicted probability of 59.9% when all predictors were present.
- Study only had five patients with septic arthritis.
- Did not have a single case of septic arthritis in a patient with no predictors present.
measurements
[]
information
+ 1 criterion - 3% probability for septic arthritis
+ 2 criteria - 40% probability for septic arthritis
+ 3 criteria - 93% probability for septic arthritis
+ 4 criteria - 99.6% probability for septic arthritis
refrences
{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/10608376", "text": "Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999 Dec;81(12):1662-70." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/15118038", "text": "Luhmann SJ, et al. Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithms. JBJS. 2004; 86(5): 956-62." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/20798450", "text": "Sultan J and Hughes PJ. Septic arthritis or transient synovitis of the hip in children: The value of clinical prediction algorithms. JBJS Britain. 2010; 92(9): 1289-93." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/15292409", "text": "Kocher MS, et al. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. JBJS. 2004; 86(8): 1629-35." } ], "Validations": [] }
pearls
The Kocher Criteria was derived to identify factors important in distinguishing septic arthritis and transient synovitis.
- Patients falling on either extreme of the criteria can be readily ruled in or out for septic arthritis in the right clinical setting.
- Patients in the intermediate range may need further work-up or intervention.
- Criteria did not perform as well in the validation study though may still be clinically useful for those on either extreme of the criteria.
usecase
The Kocher Criteria can be applied to all pediatric patients with an acutely irritable hip in whom septic arthritis and transient synovitis are in the differential diagnosis.
reasons
Differentiation between septic arthritis and transient synovitis of the hip in children can be difficult given their similar, non-traumatic presentations. The Kocher criteria can quickly identify particular subsets of patients who need urgent orthopedic consultation or can be readily observed.
next_advice
- Obtain a thorough history and physical exam on all pediatric patients presenting with an acutely irritable hip, paying particular concern to presence or history of fever and inability to bear weight.
- Draw a CBC, ESR and CRP in all patients with a clinical concern for septic arthritis or transient synovitis.
next_actions
Patients meeting none or all of the Kocher criteria can potentially be discharged (0 predictors) or require urgent orthopedics consultation for washout (4 predictors). Those with some predictors may require hip arthrocentesis.
next_management
- Consider diagnostic hip aspiration in patients with a clinical concern for septic arthritis that have at least one predictor for septic arthritis
- If there is a high clinical suspicion do not delay orthopedic consultation.
- Consider observation and/or discharge with close follow-up in well-appearing patients with a low clinical suspicion for septic arthritis and no predictors present.
diseases
[ "Acute Pain", "Septic Arthritis", "Transient Synovitis" ]
instructions
published
2022-04-21T20:29:01.804Z
purpose
[ "Diagnosis" ]
search_terms
[ "hip", "synovitis", "transient" ]
seo
{ "keywords_en": "Kocher Criteria, kocher hip, septic arthritis criteria, child hip criteria, pediatric spetic joint, septic joint criteria, hip sepsis score, kocher calc.", "meta_description_en": "The Kocher Criteria for Septic Arthritis distinguishes septic arthritis from transient synovitis in a child with an inflamed hip." }
specialty
[ "Emergency Medicine", "Infectious Disease", "Orthopedics", "Pediatric Subspecialty", "Pediatrics" ]
departments
[ "Infectious", "Musculoskeletal" ]
tags
[]
version_number
1
versions
[]
related
[ { "calcId": 1734, "short_title_en": "LRINEC Score", "slug": "lrinec-score-necrotizing-soft-tissue-infection" }, { "calcId": 10092, "short_title_en": "ACR/EULAR 2010 RA Criteria", "slug": "acr-eular-2010-rheumatoid-arthritis-classification-criteria" }, { "calcId": 4027, "short_title_en": "Jones Criteria for ARF", "slug": "jones-criteria-acute-rheumatic-fever-diagnosis" } ]
ismed
true
section
[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]
cleaned_departments
[ "infectious", "orthopedics" ]
cleaned_use
[ "The Kocher Criteria can be applied to all pediatric patients with an acutely irritable hip in whom septic arthritis and transient synovitis are in the differential diagnosis." ]
pub
true