Pediatric septic arthritis

Background

Acute septic arthritis in children is an orthopaedic emergency. A delay in diagnosis and inappropriate treatment can result in a devastating damage to the joint with lifelong disability as a consequence. The clinical presentation can be a diagnostic challenge, especially in young children. The diagnosis of acute septic arthritis is highly suggestive when pus is aspirated from the joint, in case of a positive culture or a positive gram stain of the joint fluid, or if there is a white blood-cell count in the joint fluid of more than 50000/mm3. Recent systematic reviews have identified the most effective drainage techniques, including needle aspiration, arthroscopy and arthrotomy, depending on the affected joint. However, the studies about the optimal drainage procedure of the several joints were diverse and the scientific quality was generally low. The follow-up was short and low numbers of patients were investigated. Through our proposed research we aim to better inform the patients and their parents about the long-term effects of septic arthritis in children and hopefully improve treatment in the future.

Objective

To assess the long-term clinical outcomes using Patient-reported Outcome Measures (PROMS), physical examination and radiological sequelae of acute septic arthritis in children.

Design

Multi-center retrospective cohort study

Study population: All patients aged 0 to 17 years during the diagnosis of acute septic arthritis in five participating hospitals with a minimum of 5 years follow-up will be invited for participation.

Main study parameters/endpoints: The patient-reported outcome measures (PROMs) consist of two general questionnaires and one joint-specific outcome measure. Radiographs of the affected joints will be analysed for long-term sequelae and degenerative changes.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The Patient-reported Outcome Measures (PROMs) questionnaires will be digitally sent to the patients before the visit. The PROMs consist of; two general questionnaires (Pediatric Outcomes Data Collection Instrument (PODCI) and Pediatric Quality of Life (PedsQL)) and one joint-specific PROM. During this visit, the range of motion of the affected and contralateral joints, any length discrepancy and growth disturbance will be assessed. X-rays will be made for radiological evaluation of any sequelae, including cartilage degeneration, osteo-arthritis and avascular necrosis. The collected data will be coded, processed and archived in the data management system of Amphia (CASTOR).