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Diagnosing acute bone and joint infection in children: how does imaging alter the probability of infection?

Diagnosing acute bone and joint infection in children: how does imaging alter the probability of infection?
Diagnosing acute bone and joint infection in children: how does imaging alter the probability of infection?

Acute bone and joint infections in children are serious, and misdiagnosis can threaten limb and life. Most young children who present acutely with pain, limping, and/or loss of function have transient synovitis, which will resolve spontaneously within a few days. A minority will have a bone or joint infection. Clinicians are faced with a diagnostic challenge: children with transient synovitis can safely be sent home, but children with bone and joint infection require urgent treatment to avoid complications. Clinicians often respond to this challenge by using a series of rudimentary decision support tools, based on clinical, haematological, and biochemical parameters, to differentiate childhood osteoarticular infection from other diagnoses. However, these tools were developed without methodological expertise in diagnostic accuracy and do not consider the importance of imaging (ultrasound scan and MRI). There is wide variation in clinical practice with regard to the indications, choice, sequence, and timing of imaging. This variation is most likely due to the lack of evidence concerning the role of imaging in acute bone and joint infection in children. We describe the first steps of a large UK multicentre study, funded by the National Institute for Health Research, which seeks to integrate definitively the role of imaging into a decision support tool, developed with the assistance of individuals with expertise in the development of clinical prediction tools.

2049-4394
227-229
Theologis, Tim
abab4985-ace5-41b3-9f74-7d8e24002c80
Brady, Mariea A.
cecc3f2e-95c9-4a7c-b427-d525345a085c
Hartshorn, Stuart
39df7960-a90f-446f-9840-9f6748111fbd
Faust, Saul N.
f97df780-9f9b-418e-b349-7adf63e150c1
Offiah, Amaka C.
ef1703e9-d951-4499-adb7-292bbd031bbd
Theologis, Tim
abab4985-ace5-41b3-9f74-7d8e24002c80
Brady, Mariea A.
cecc3f2e-95c9-4a7c-b427-d525345a085c
Hartshorn, Stuart
39df7960-a90f-446f-9840-9f6748111fbd
Faust, Saul N.
f97df780-9f9b-418e-b349-7adf63e150c1
Offiah, Amaka C.
ef1703e9-d951-4499-adb7-292bbd031bbd

Theologis, Tim, Brady, Mariea A., Hartshorn, Stuart, Faust, Saul N. and Offiah, Amaka C. (2023) Diagnosing acute bone and joint infection in children: how does imaging alter the probability of infection? The Bone & Joint Journal, 105-B (3), 227-229. (doi:10.1302/0301-620X.105B3.BJJ-2022-1179.R1).

Record type: Article

Abstract

Acute bone and joint infections in children are serious, and misdiagnosis can threaten limb and life. Most young children who present acutely with pain, limping, and/or loss of function have transient synovitis, which will resolve spontaneously within a few days. A minority will have a bone or joint infection. Clinicians are faced with a diagnostic challenge: children with transient synovitis can safely be sent home, but children with bone and joint infection require urgent treatment to avoid complications. Clinicians often respond to this challenge by using a series of rudimentary decision support tools, based on clinical, haematological, and biochemical parameters, to differentiate childhood osteoarticular infection from other diagnoses. However, these tools were developed without methodological expertise in diagnostic accuracy and do not consider the importance of imaging (ultrasound scan and MRI). There is wide variation in clinical practice with regard to the indications, choice, sequence, and timing of imaging. This variation is most likely due to the lack of evidence concerning the role of imaging in acute bone and joint infection in children. We describe the first steps of a large UK multicentre study, funded by the National Institute for Health Research, which seeks to integrate definitively the role of imaging into a decision support tool, developed with the assistance of individuals with expertise in the development of clinical prediction tools.

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More information

Published date: 1 March 2023
Additional Information: Funding statement: The authors disclose receipt of the following financial support for the research, authorship and publication of this article: This research is funded by the Health Technology Assessment/National Institute for Health and Care Research grant no. 134125.

Identifiers

Local EPrints ID: 476919
URI: http://eprints.soton.ac.uk/id/eprint/476919
ISSN: 2049-4394
PURE UUID: 206c8ea0-8e8b-41dc-97fc-6dd77654d835
ORCID for Saul N. Faust: ORCID iD orcid.org/0000-0003-3410-7642

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Date deposited: 19 May 2023 16:37
Last modified: 20 May 2023 01:38

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Contributors

Author: Tim Theologis
Author: Mariea A. Brady
Author: Stuart Hartshorn
Author: Saul N. Faust ORCID iD
Author: Amaka C. Offiah

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