RESUMEN
Pediatric septic arthritis (SA), an intra-articular infection in children, is considered a surgical emergency. The most commonly affected joints are the lower limb joints. It is more common in children below five years old and in males. Several scoring systems aid in the prediction of the disease and help differentiate it from similar differential diagnoses (such as transient synovitis (TS)). The first and most famous scoring system is Kocher's Criteria (KC), which utilizes a mixture of clinical signs, symptoms, and laboratory markers to predict the likelihood of the diagnosis. This review aims to assess the current literature to look at primary papers comparing the predicted probability of KC to the original probability described therefore evaluating its efficacy and usefulness in today's pediatric population. PubMed was searched using the terms "septic arthritis AND hip AND (Kocher OR Kocher's criteria)," 27 studies resulted, and each study was screened by reading the abstracts. Six studies were included in this review. Inclusion criteria were any study that looked at SA of the hip in the pediatric population prospectively or retrospectively, using KC to help make a diagnosis and looking at the predicted probability of KC. Exclusion criteria included studies looking at adults, joints other than the hip, and papers not assessing the predicted probability. The efficacy of KC for diagnosing SA is not well-supported by current literature. Studies indicate that KC have low specificity for SA, suggesting it should not replace arthrocentesis as the diagnostic gold standard. Clinicians should use this model cautiously, and more extensive, prospective studies are needed to validate its effectiveness.
RESUMEN
In recent years, healthcare education providers have boasted about a conscious shift towards increasing clinical competence via assessment tests that promote more active learning. Despite this, multiple-choice questions remain amongst the most prevalent forms of assessment. Various literature justifies the use of multiple-choice testing by its high levels of validity and reliability. Education providers also benefit from requiring fewer resources and costs in the development of questions and easier adaptivity of questions to compensate for neurodiversity. However, when testing these (and other) variables via a structured approach in terms of their utility, it is elucidated that these advantages are largely dependent on the quality of the questions that are written, the level of clinical competence that is to be attained by learners and the impact of negating confounding variables such as differential attainment. Attempts at improving the utility of multiple-choice question testing in modern healthcare curricula are discussed in this review, as well as the impact of these modifications on performance.