Emergency Department Management of Pediatric Septic Arthritis and Osteomyelitis -

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Publication Date: December 2019 (Volume 16, Number 12)

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Abstract

Septic arthritis and osteomyelitis in pediatric patients represent true emergencies, and can quickly threaten life and limb. A high index of suspicion should be maintained, as these conditions often present with a subacute course of illness and vague signs and symptoms. Septic arthritis and osteomyelitis can occur concurrently, so suspicion for one should also prompt investigation for the other. The diagnostic evaluation should include blood work as well as samples from the infected joint or bone for culture. Management with antibiotics is a standard approach, but the duration of antibiotic therapy is controversial. This issue reviews the current literature and provides an evidence-based approach for the evaluation and management of pediatric patients with septic arthritis and osteomyelitis.

Excerpt From This Issue

A 15-month-old boy presents to the ED with sudden onset of fever to 39.5°C (103.1°F), left knee swelling, and refusal to bear weight. His mother reports that the boy fell 2 days prior. He had a minor abrasion with some mild swelling to the left knee, but he was walking normally. This morning, the boy woke up with a fever, increased swelling and warmth of the left knee, and he refused to bear weight on the left leg. He is otherwise healthy, with no medical or surgical history. Aside from ibuprofen, he has not been given any other medication. His vital signs are notable for fever and tachycardia. During the physical examination, he refuses to walk and asks to be held. The right knee is normal, with normal range of motion. The left knee is erythematous, swollen, and has limited range of motion. You discuss with the mother that the differential diagnosis for this presentation is broad, and you would like to obtain some lab tests and imaging. You order acetaminophen for the persistent fever as well as a complete blood cell count, erythrocyte sedimentation rate, C-reactive protein, blood cultures, and plain radiography. You begin to think: Do you need to obtain additional imaging studies? What procedures should be performed?