QingSong Tang, XinLing Miao, Xiang Ren, Kang Zhao, Jie Hu
Orthopedics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
School of Nursing, Chengdu university, Chengdu, 610106, China.
BMC Infect Dis. 2024 Dec 18;24(1):1432. doi: 10.1186/s12879-024-10341-z.
Septic arthritis (SA) of the hip joint is a serious infection that can result in irreversible complications. Distinguishing septic arthritis from transient synovitis, the most common cause of hip pain in children, is crucial for preventing severe outcomes. Existing research has primarily focused on identifying clinical signs and laboratory findings that indicate high-risk patients who may need invasive diagnostic procedures; however, results have been inconsistent. This study aims to evaluate the correlation of various clinical indicators in differentiating septic arthritis from pediatric transient synovitis of the hip.
This study followed the PRISMA guidelines rigorously and was registered with PROSPERO. We conducted a systematic search of PubMed, Embase, and Cochrane Library databases for relevant literature up to September 2024. Studies included in the analysis were required to evaluate the predictive value of clinical indicators distinguishing septic arthritis and transient synovitis of the hip in children under 18 years of age. The risk of bias and quality of the included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and RevMan 5.3. Data synthesis was performed using Stata MP-64 18.0 software to facilitate meta-analysis.
A total of eleven studies were ultimately included for the final analysis, comprising 1810 cases. The results of meta-analysis revealed that history of fever emerged as a significant risk factor for differentiating septic arthritis from pediatric transient synovitis of the hip (OR = 6.04, 95% CI = 2.44-14.97, P < 0.001). Other notable risk factors included non-weight-bearing status (OR = 5.23, 95% CI = 1.38-19.75, P = 0.015), erythrocyte sedimentation rate (OR = 3.98, 95% CI = 1.29-12.30, P = 0.017), and serum white blood cell count (OR = 2.73, 95% CI = 1.23-6.03, P = 0.013). In contrast, C-reactive protein was not a significant risk factor (OR = 7.12, 95% CI = 0.59-85.70, P = 0.122).
The clinical indicators involving a history of fever, non-weight-bearing status, erythrocyte sedimentation rate, and serum white blood cell count have been identified as cost-effective routine tests with potential value in differentiating septic arthritis from pediatric transient synovitis of the hip. To enhance the reliability of these findings, further prospective studies are essential.
Not applicable.
髋关节化脓性关节炎（SA）是一种严重感染，可导致不可逆的并发症。区分化脓性关节炎与儿童髋关节疼痛最常见的病因——暂时性滑膜炎，对于预防严重后果至关重要。现有研究主要集中于识别可能需要进行侵入性诊断程序的高危患者的临床体征和实验室检查结果；然而，结果并不一致。本研究旨在评估各种临床指标在区分化脓性关节炎与儿童髋关节暂时性滑膜炎方面的相关性。
本研究严格遵循PRISMA指南，并在PROSPERO注册。我们对PubMed、Embase和Cochrane图书馆数据库进行了系统检索，以获取截至2024年9月的相关文献。纳入分析的研究需评估区分18岁以下儿童化脓性关节炎和髋关节暂时性滑膜炎的临床指标的预测价值。使用诊断准确性研究质量评估-2（QUADAS-2）和RevMan 5.3评估纳入研究的偏倚风险和质量。使用Stata MP-64 18.0软件进行数据合成，以促进荟萃分析。
最终共纳入11项研究进行最终分析，包括1810例病例。荟萃分析结果显示，发热史是区分化脓性关节炎与儿童髋关节暂时性滑膜炎的重要危险因素（OR = 6.04，95%CI = 2.44-14.97，P < 0.001）。其他显著危险因素包括非负重状态（OR = 5.23，95%CI = 1.38-19.75，P = 0.015）、红细胞沉降率（OR = 3.98，95%CI = 1.29-12.30，P = 0.017）和血清白细胞计数（OR = 2.73，95%CI = 1.23-6.03，P = 0.013）。相比之下，C反应蛋白不是显著危险因素（OR = 7.12，95%CI = 0.59-85.70，P = 0.122）。
涉及发热史、非负重状态、红细胞沉降率和血清白细胞计数的临床指标已被确定为具有成本效益的常规检查，在区分化脓性关节炎与儿童髋关节暂时性滑膜炎方面具有潜在价值。为提高这些研究结果的可靠性，进一步的前瞻性研究至关重要。
不适用。
