Abstract
BackgroundReported complications of pediatric septic arthritis range from minor growth abnormalities to potentially life-threatening conditions and death; some children require multiple surgeries for eradication of infection. The purpose of this study is: (1) to determine the failure rate of a single surgical incision and drainage (I&D) in pediatric septic arthritis, (2) to identify risk factors for failure which are detectable at the time of initial presentation, and (3) to trend post-operative C-reactive protein (CRP) values to see if there is a difference between children who fail a single I&D and those who do not.MethodsThe medical records for 105 children who underwent operative management of septic arthritis were retrospectively reviewed. Single and multivariate analyses were performed.ResultsEighty-four children required one surgical intervention [mean age 5.18 years (±4.01); 38 females (45 %), 46 males (55 %)], 21 children required revision surgery [mean age 8.16 years (±4.54); 4 females (19 %), 17 males (81 %)], and the overall rate of revision surgery was 20 %. Delayed diagnosis (p = 0.015), elevated CRP at presentation (p = 0.000), positive blood culture (p = 0.000), and age (p = 0.009) were all associated with revision surgery in bivariate analysis. In multivariate analysis, CRP at presentation and positive blood culture were significant risk factors for revision surgery (p = 0.005 and p = 0.025, respectively). Additionally, markedly elevated CRP levels on post-operative days (POD) 1–4 were each independently significant risk factors for requiring multiple surgeries (all p < 0.000). Fever, elevated erythrocyte sedimentation rate, and leukocyte count were not risk factors for multiple surgeries.ConclusionsIn this study, a positive blood culture or marked elevation in CRP at presentation or on POD 1–4 were associated with revision surgery. These findings may help improve surgical planning for both the initial surgery in order to avoid revisions, as well as revision surgery, should it be indicated.Level of evidenceIII.Electronic supplementary materialThe online version of this article (doi:10.1007/s11832-016-0736-6) contains supplementary material, which is available to authorized users.
Highlights
Septic arthritis is an emergency comprising 21 % of acute pediatric musculoskeletal infections [1], with a reported incidence of 5–12 cases per 100,000 personyears [2]
The purpose of this study is: (1) to determine the failure rate of a single surgical incision and drainage (I&D) in pediatric septic arthritis, (2) to identify risk factors for failure which are detectable at the time of initial presentation, and (3) to trend post-operative C-reactive protein (CRP) values to see if there is a difference between children who fail a single I&D and those who do not
In this study, a positive blood culture or marked elevation in CRP at presentation or on post-operative days (POD) 1–4 were associated with revision surgery
Summary
Septic arthritis is an emergency comprising 21 % of acute pediatric musculoskeletal infections [1], with a reported incidence of 5–12 cases per 100,000 personyears [2]. In our review of the English-language literature, no study to date has sought to explore objective differences between children with septic arthritis who failed initial surgical I&D, necessitating additional operative intervention, and children who experienced rapid clinical improvement This information would be of clinical value in identifying at-risk children early during their disease course, so as to better improve patient care, minimize complications, and facilitate initial family counseling. The purpose of this study is: (1) to determine the failure rate of a single surgical incision and drainage (I&D) in pediatric septic arthritis, (2) to identify risk factors for failure which are detectable at the time of initial presentation, and (3) to trend post-operative C-reactive protein (CRP) values to see if there is a difference between children who fail a single I&D and those who do not
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