Clinical Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel.
Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Pediatr. 2014 Nov;165(5):985-9.e1. doi: 10.1016/j.jpeds.2014.07.060. Epub 2014 Sep 10.
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.
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.
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.
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.
进行回顾性多中心研究，以评估一种预测算法区分金氏金氏菌髋关节感染儿童和暂时性滑膜炎儿童的能力。
回顾了 25 名以色列和 9 名西班牙儿童的医疗记录，这些儿童年龄在 6-27 个月之间，经培养证实患有金氏金氏菌髋关节关节炎，并收集了常用 Kocher 预测算法（体温、拒承重、白细胞增多和红细胞沉降率）中包含的 4 个变量的信息。
患有 K 金氏菌关节炎的患者通常表现出轻度异常的临床表现和正常或接近正常的血清急性期反应物水平。所有 4 个变量的数据均可用于 28 名（82%）儿童，其中 1 名儿童无任何症状，6 名儿童有 1 个，13 名儿童有 2 个，5 名儿童有 3 个，只有 3 名儿童有 4 个预测因素，这意味着 20 名（71%）儿童的感染性关节炎概率≤40%。
由于 3 岁以下儿童髋关节金氏金氏菌关节炎和暂时性滑膜炎的特征重叠，Kocher 预测算法不足以区分这两种情况。对于出现髋关节刺激的年幼儿童，即使没有发热、白细胞增多或高 Kocher 评分，也应进行血液培养和核酸扩增检测以排除 K 金氏菌关节炎。
