Sultan J, Hughes P J
Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom.
J Bone Joint Surg Br. 2010 Sep;92(9):1289-93. doi: 10.1302/0301-620X.92B9.24286.
The crucial differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. In 1999, Kocher et al introduced four clinical predictors which were highly predictive (99.6%) of septic arthritis. These included fever (temperature > or = 38.5 degrees C), inability to bear weight, white blood-cell count > 12.0 x 10(9) cells/L and ESR > or = 40 mm/hr; CRP > or = 20 mg/L was later added as a fifth predictor. We retrospectively evaluated these predictors to differentiate septic arthritis from transient synovitis of the hip in children over a four-year period in a primary referral general hospital. When all five were positive, the predicted probability of septic arthritis in this study was only 59.9%, with fever being the best predictor. When applied to low-prevalence diseases, even highly specific tests yield a high number of false positives and the predictive value is thereby diminished. Clinical predictors should be applied with caution when assessing a child with an irritable hip, and a high index of suspicion, and close observation of patients at risk should be maintained.
区分儿童化脓性关节炎和髋关节一过性滑膜炎具有一定难度。1999年，科赫尔等人提出了四项临床预测指标，这些指标对化脓性关节炎具有高度预测性（99.6%）。其中包括发热（体温≥38.5℃）、无法负重、白细胞计数＞12.0×10⁹个/L以及红细胞沉降率（ESR）≥40mm/小时；后来又增加了C反应蛋白（CRP）≥20mg/L作为第五项预测指标。我们在一家一级转诊综合医院对这些预测指标进行了回顾性评估，以区分四年期间儿童化脓性关节炎和髋关节一过性滑膜炎。在本研究中，当所有五项指标均为阳性时，化脓性关节炎的预测概率仅为59.9%，其中发热是最佳预测指标。当应用于低患病率疾病时，即使是高特异性的检查也会产生大量假阳性结果，从而降低预测价值。在评估髋关节疼痛的儿童时，应谨慎应用临床预测指标，保持高度怀疑，并对高危患者进行密切观察。
