Theologis Tim, Brady Mariea A, Hartshorn Stuart, Faust Saul N, Offiah Amaka C
Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK.
St Helens and Knowsley NHS Teaching Hospital Trust, Whiston Hospital, Liverpool, UK.
Bone Joint J. 2023 Mar 1;105-B(3):227-229. doi: 10.1302/0301-620X.105B3.BJJ-2022-1179.R1.
Acute bone and joint infections in children are serious, and misdiagnosis can threaten limb and life. Most young children who present acutely with pain, limping, and/or loss of function have transient synovitis, which will resolve spontaneously within a few days. A minority will have a bone or joint infection. Clinicians are faced with a diagnostic challenge: children with transient synovitis can safely be sent home, but children with bone and joint infection require urgent treatment to avoid complications. Clinicians often respond to this challenge by using a series of rudimentary decision support tools, based on clinical, haematological, and biochemical parameters, to differentiate childhood osteoarticular infection from other diagnoses. However, these tools were developed without methodological expertise in diagnostic accuracy and do not consider the importance of imaging (ultrasound scan and MRI). There is wide variation in clinical practice with regard to the indications, choice, sequence, and timing of imaging. This variation is most likely due to the lack of evidence concerning the role of imaging in acute bone and joint infection in children. We describe the first steps of a large UK multicentre study, funded by the National Institute for Health Research, which seeks to integrate definitively the role of imaging into a decision support tool, developed with the assistance of individuals with expertise in the development of clinical prediction tools.
儿童急性骨与关节感染病情严重，误诊会对肢体和生命构成威胁。多数急性出现疼痛、跛行及/或功能丧失的幼儿患有暂时性滑膜炎，该病会在数天内自行缓解。少数患儿会发生骨或关节感染。临床医生面临诊断难题：患有暂时性滑膜炎的儿童可安全送回家，但患有骨与关节感染的儿童需要紧急治疗以避免并发症。临床医生常通过使用一系列基于临床、血液学和生化参数的初级决策支持工具来应对这一难题，以区分儿童骨关节炎感染与其他病症。然而，这些工具在开发时缺乏诊断准确性方面的方法学专业知识，且未考虑影像学检查（超声扫描和磁共振成像）的重要性。在影像学检查的适应症、选择、顺序和时机方面，临床实践存在很大差异。这种差异很可能是由于缺乏关于影像学在儿童急性骨与关节感染中作用的证据。我们描述了一项由英国国家卫生研究院资助的大型多中心研究的初步步骤，该研究旨在将影像学的作用明确整合到一个决策支持工具中，该工具是在临床预测工具开发方面具有专业知识的人员协助下开发的。
