“CLINICO-LABORATORY PROFILE OF PEDIATRIC SEPTIC ARTHRITIS AND ITS DIFFERENTIATION FROM TRANSIENT SYNOVITIS: A RETROSPECTIVE STUDY
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Keywords
Septic arthritis, Transient synovitis, Kocher criteria, Paediatric joint infection, C-reactive protein, Staphylococcus aureus, Synovial fluid analysis
Abstract
Background: Differentiating pediatric septic arthritis (SA) from transient synovitis (TS) is a critical diagnostic challenge. This study evaluated the clinico-laboratory profiles of both conditions and the performance of the Kocher criteria in a tertiary care setting in Central India.
Methods: This retrospective observational study (October 2021–September 2022) included 30 pediatric patients (SA: n=12; TS: n=18). Demographic, clinical, laboratory (WBC, ESR, CRP), and microbiological data were analyzed. The Kocher criteria were retrospectively applied, and statistical significance was set at p < 0.05.
Results: SA patients were significantly younger (3.4 vs. 5.8 years, p < 0.05). High-grade fever (83.3% vs. 16.7%) and non-weight-bearing status (91.7% vs. 38.9%) were significantly more prevalent in SA (p < 0.01$). Inflammatory markers were markedly higher in SA: WBC (14,500 vs. 9,200 cells/mm³), ESR (52 vs. 18 mm/hr), and CRP (64 vs. 12 mg/L) (p < 0.001$). Staphylococcus aureus was the most common pathogen (75% synovial fluid culture positivity). SA probabilities using Kocher criteria were 3%, 38%, 91%, and 98% for 1, 2, 3, and 4 predictors, respectively.
Conclusion: A multiparametric approach using clinical features, inflammatory markers (especially CRP and ESR), and the Kocher criteria reliably differentiates SA from TS. Early empirical anti-staphylococcal therapy is vital. The Kocher criteria remain a robust tool for resource-limited settings.
References
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Dr Satendra Singh Rajput
Assistant professor , Department of pediatrics , Gajra Raja Medical College, Gwalior
Dr Priyanka Rajput
Demonstrator, Department of Physiology , Gajra Raja Medical College, Gwalior
Dr Ritesh Singh Yadav
Assistant Professor, Department Of Orthopaedic , Index Medical College Malwanchal University, Indore.
Dr Ramniwas. Mahore
Assistant Professor, Community Medicine Department, Gajra Raja Medical College, Gwalior
