The limping child: an algorithm to outrule musculoskeletal sepsis.
AffiliationDepartment of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland., Delaney.firstname.lastname@example.org
Bone Diseases, Infectious/*diagnosis
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CitationIr J Med Sci. 2007 Sep;176(3):181-7. Epub 2007 Jul 12.
JournalIrish journal of medical science
AbstractBACKGROUND: The acutely limping child presents a significant diagnostic challenge. AIM: The purpose of this study was to create a clinically useful algorithm to allow exclusion of 'musculoskeletal sepsis' as a differential diagnosis in the child presenting with limp. METHODS: Data were collected on all 286 limping children admitted to our centre over a 3-year-period. Using logistic regression analysis, the predictive model was constructed, to exclude infection. RESULTS: Duration of symptoms, constitutional symptoms, temperature, white cell count and ESR were significantly different in children with musculoskeletal infection (P < 0.05). Multivariate analysis demonstrated that when all three variables of duration of symptoms >1, <5 days; temperature >37.0 degrees C; and ESR >35 mm/h were present, the predicted probability of infection was 0.66, falling to 0.01 when none were present. CONCLUSION: This multivariate model enables us to rule out musculoskeletal infection with 99% certainty in limping children with none of these three presenting variables.