Acute septic arthritis of the hip in children in northern Australia

Abstract

Background: The epidemiology, microbiology and clinical management of all children under 15 years of age presenting with acute septic arthritis of the hip to Royal Darwin Hospital from July 1994 to December 1999 were reviewed and the diagnostic value of various biological markers assessed.

Methods: Systematic review was undertaken of case notes of patients identified by searching the computerized hospital patient database and the admission records for the children's ward.

Results: Eleven cases were identified: 10 aboriginal and one caucasian. The mean temperature, white cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) at presentation were 39.2 degrees C, 15,500/mL, 65 mm/h and 144 mg/L, respectively. All had ESR and/or CRP >20. Plain radiographs and ultrasonography were abnormal in 1/8 and 5/6 cases, respectively. Pathogens were isolated in nine cases: Staphylococcus aureus (n = 6), Streptococcus pyogenes (n = 2) and Streptococcus pneumoniae (n = 1). Patients received intravenous antibiotics for 8.6 days (range: 3-15 days) and subsequent oral antibiotics for 22 days (range: 0-42 days). The mean (range) time from hospital admission to arthrotomy; from hospital admission to antibiotic administration; and the overall hospital stay was 23 h (range: 3-48 h); 6 h (range: 0-48 h); and 41 days (range: 6-110 days), respectively.

Conclusions: Elevation of temperature, white cell count, ESR and CRP were useful indicators of septic arthritis but initial diagnosis must be made on a clinical basis. Many patients had to be transferred from regional aboriginal communities and there was significant delay from onset of symptoms to arthrotomy.