Emergency Department Management of Pediatric Septic Arthritis and Osteomyelitis

Points & Pearls Excerpt

• Septic arthritis (SA) and osteomyelitis (OM) require prompt evaluation and treatment, as both can quickly lead to loss of life or limb.
• Presenting symptoms in pediatric patients can be nonspecific and vary based on age.
• Neonates and infants with SA present acutely with septicemia, cellulitis, or fever without a source; older children most commonly present with acute fever, joint pain/limited range of motion, and/or refusal to bear weight.
• Children with OM have symptoms that progress over several days to a week and often have low-grade or no fever, focal findings of bone inflammation (eg, warmth, swelling, tenderness), and limited range of motion. Prematurity, hemoglobinopathies, and com-promised immunity increase the risk for OM.

Most Important References

• Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999;81(12):1662-1670. (Retrospective; 282 cases) 
• Kang SN, Sanghera T, Mangwani J, et al. The management of septic arthritis in children: systematic review of the English language literature. J Bone Joint Surg Br. 2009;91(9):1127-1133. (Systematic review; 154 studies) 
• Burnett MW, Bass JW, Cook BA. Etiology of osteomyelitis complicating sickle cell disease. Pediatrics. 1998;101(2):296- 297. (Review) 
• Howard-Jones AR, Isaacs D. Systematic review of duration and choice of systemic antibiotic therapy for acute haematogenous bacterial osteomyelitis in children. J Paediatr Child Health. 2013;49(9):760-768. (Systematic review; 34 studies, 6 randomized controlled trials and 28 observational studies) 
• Peltola H, Paakkonen M. Acute osteomyelitis in children. N Engl J Med. 2014;370(4):352-360. (Review)