Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland 44195, OH, USA.
Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland 44195, OH, USA.
J Plast Reconstr Aesthet Surg. 2024 May;92:254-263. doi: 10.1016/j.bjps.2024.03.015. Epub 2024 Mar 26.
The existing diagnostic criteria for septic wrist are nonspecific, exposing patients with noninfectious etiologies to surgical morbidity. This study aimed to identify predictors differentiating septic wrist from other etiologies.
An institutional review board-approved retrospective review was conducted on patients with a presumed diagnosis of septic wrist (2003-2022). Bivariate and multiple regression analyses were performed to identify correlation between confirmed septic wrist and comorbidities (autoimmune diseases, immunosuppression, crystalline arthropathy, intravenous [IV] drug use, smoking), penetrating trauma, fever, multi-joint involvement, inflammatory markers (erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP]/white blood cells [WBC]), serum uric acid level, blood cultures, imaging findings, and synovial fluid analysis. Categorical data were reported as median [interquartile range].
Hundred and sixty-eight (58 females and 110 males) patients were included. The median length of hospitalization and follow-up were 6[7] days and 1[3] months. Eighty-nine (53%) patients had septic wrist confirmed with Gram stain/culture, 48 (29%) patients received alternative diagnoses, and 31 (18%) patients had undetermined diagnoses. Concomitant septic wrist and crystalline arthropathy were identified in 9 patients (6.6% of total patients). Out of the 48 patients who received alternative diagnoses, 12 (25%) underwent open drainage. Elevated synovial WBC count (95,409.4 ± 85,926.2) showed a trend of association with septic wrist (p = 0.08). Negative synovial crystals (p = 0.01), positive blood culture (p = 0.04), negative history of crystalline arthropathy (p = 0.08), and multi-joint involvement (p = 0.05) were identified as predictors of septic wrist with a combined sensitivity of 87.5%, specificity of 86.2%, and area under the curve 0.93.
Current diagnostic criteria for septic wrist have low specificity. Negative history of crystalline arthropathy, multi-joint involvement, absence of synovial crystals, and positive blood culture are helpful indicators for predicting septic wrist in patients presenting with a painful, erythematous, and swollen wrist.
现有的脓毒性腕关节诊断标准不具特异性，使非感染性病因的患者面临手术并发症的风险。本研究旨在确定区分脓毒性腕关节与其他病因的预测指标。
对 2003 年至 2022 年间被诊断为疑似脓毒性腕关节的患者进行了一项机构审查委员会批准的回顾性研究。采用二变量和多变量回归分析来确定经证实的脓毒性腕关节与合并症（自身免疫性疾病、免疫抑制、结晶性关节炎、静脉[IV]药物使用、吸烟）、穿透性创伤、发热、多关节受累、炎症标志物（红细胞沉降率[ESR]/C 反应蛋白[CRP]/白细胞[WBC]）、血清尿酸水平、血培养、影像学发现和滑液分析之间的相关性。分类数据以中位数[四分位数范围]报告。
共纳入 168 名患者（58 名女性和 110 名男性）。中位住院和随访时间分别为 6[7]天和 1[3]个月。89 名（53%）患者的革兰氏染色/培养结果证实为脓毒性腕关节，48 名（29%）患者得到了其他诊断，31 名（18%）患者的诊断结果不确定。9 名（6.6%的总患者）患者同时存在脓毒性腕关节和结晶性关节炎。在 48 名接受其他诊断的患者中，有 12 名（25%）患者接受了切开引流。高关节滑液白细胞计数（95409.4±85926.2）显示出与脓毒性腕关节相关的趋势（p=0.08）。滑液无结晶（p=0.01）、血培养阳性（p=0.04）、无结晶性关节炎病史（p=0.08）和多关节受累（p=0.05）被确定为脓毒性腕关节的预测指标，联合敏感性为 87.5%，特异性为 86.2%，曲线下面积为 0.93。
目前脓毒性腕关节的诊断标准特异性较低。无结晶性关节炎病史、多关节受累、无滑液结晶和血培养阳性是预测有疼痛、红肿和肿胀的腕关节患者发生脓毒性腕关节的有用指标。
