Children's Minnesota Research Institute.
Department of Orthopedic Surgery, Gillette Children's Specialty Healthcare, St. Paul, MN.
J Pediatr Orthop. 2022 Feb 1;42(2):e212-e217. doi: 10.1097/BPO.0000000000002024.
Pediatric musculoskeletal infection (MSKI) is a bacterial infection of the bone, joint, and/or muscle that can be difficult to diagnose. The Kocher and Caird algorithms were developed to distinguish septic arthritis (SA) from transient synovitis (TS) in the hip. These algorithms have been applied to all patients presenting with painful, swollen monoarticular joints regardless of suspicion for SA. The aim of this analysis was to assess the test performance of Kocher and Caird to distinguish MSKI among all pediatric patients presenting with monoarticular joint pain. A secondary aim was to validate the original algorithms.
We conducted a secondary analysis of a prospective cohort study evaluating the test performance of procalcitonin for suspected SA in a pediatric emergency department. Patients aged 0 to 16 years old who presented with a painful or swollen monoarticular joint were considered for enrollment. We compared the test performance of the traditional algorithms in an expanded population of MSKI versus alternate joint pain using sensitivity, specificity, and area under the curve (AUC). As a sensitivity analysis, missing data for predictors like temperature, erythrocyte sedimentation rate, C-reactive protein, and inability to bear weight were multiply imputed using the Stata program, mi impute, for changed equations.
The Caird algorithm had better test performance compared to the Kocher in all populations. Both algorithms were most discriminative in comparing SA to TS in all joints (AUC: 0.84 Caird and 0.75 Kocher). However, the Caird criteria performed almost as well discriminating MSKI from other causes of monoarticular joint pain in all joints (AUC: 0.79; 95% confidence interval: 0.72, 0.85) and nonhip joints (AUC: 0.80; 95% confidence interval: 0.71, 0.88).
Based on the findings of this study, it is clinically reasonable to apply the Caird algorithm to pediatric patients presenting with monoarticular joint pain of medium and large joints such as the knee, ankle, shoulder, elbow, and wrist, in addition to the hip.
Level III-retrospective study of novel applications of SA algorithms.
小儿肌肉骨骼感染（MSKI）是一种骨骼、关节和/或肌肉的细菌感染，可能难以诊断。科赫和凯尔德算法被开发用于区分髋关节的脓毒性关节炎（SA）和一过性滑膜炎（TS）。这些算法已应用于所有出现疼痛、肿胀的单关节炎患者，无论是否怀疑有 SA。本分析的目的是评估科赫和凯尔德在所有出现单关节炎疼痛的儿科患者中区分 MSKI 的测试性能。次要目的是验证原始算法。
我们对一项前瞻性队列研究进行了二次分析，该研究评估了降钙素原在儿科急诊室疑似 SA 中的测试性能。年龄在 0 至 16 岁之间出现疼痛或肿胀的单关节炎的患者被考虑入组。我们比较了传统算法在扩展的 MSKI 人群与替代关节疼痛中的表现，使用敏感性、特异性和曲线下面积（AUC）。作为敏感性分析，使用 Stata 程序 mi impute 对诸如体温、红细胞沉降率、C 反应蛋白和无法负重等预测因素的缺失数据进行了多次插补，以改变方程。
在所有人群中，凯尔德算法的测试性能均优于科赫算法。在所有关节中，两种算法在比较 SA 与 TS 时最具鉴别力（AUC：0.84 凯尔德和 0.75 科赫）。然而，在所有关节（AUC：0.79；95%置信区间：0.72，0.85）和非髋关节（AUC：0.80；95%置信区间：0.71，0.88）中，凯尔德标准对区分 MSKI 与其他单关节炎疼痛原因的表现几乎相同。
基于这项研究的发现，临床上可以合理地将凯尔德算法应用于出现膝关节、踝关节、肩关节、肘关节和腕关节等中大型关节单关节炎疼痛的儿科患者，而不仅仅是髋关节。
三级-对 SA 算法的新应用的回顾性研究。
