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Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area.
Grant, Duncan S; Neville, Desiree N; Levas, Michael; Balamuth, Fran; Garro, Aris C; Bennett, Jonathan E; Thompson, Amy D; Kharbanda, Anupam B; Lyons, Todd W; Nigrovic, Lise E.
Afiliación
  • Grant DS; From the Brown University, Providence, RI.
  • Neville DN; Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
  • Levas M; Division of Pediatric Emergency Medicine, Children's Hospital of Wisconsin, Milwaukee, WI.
  • Balamuth F; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Garro AC; Departments of Pediatrics and Emergency Medicine, Hasbro Children's Hospital, Providence, RI.
  • Bennett JE; Division of Emergency Medicine, Nemours/A.I. duPont Hospital for Children, Wilmington, DE.
  • Thompson AD; Division of Emergency Medicine, Nemours/A.I. duPont Hospital for Children, Wilmington, DE.
  • Kharbanda AB; Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN.
  • Lyons TW; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
  • Nigrovic LE; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
Pediatr Emerg Care ; 38(2): e881-e885, 2022 Feb 01.
Article en En | MEDLINE | ID: mdl-34160185
OBJECTIVE: In Lyme disease endemic areas, Lyme and septic arthritis often present similarly. A published septic knee arthritis clinical prediction rule includes 2 high-risk predictors: absolute neutrophil count of 10,000 cells/mm3 or greater and erythrocyte sedimentation rate of 40 mm/h or greater. The objective of the study was to externally validate this prediction rule in a multicenter prospective cohort. METHODS: We enrolled a prospective cohort of children with knee monoarthritis undergoing evaluation for Lyme disease at 1 of 8 Pedi Lyme Net emergency departments located in endemic areas. We defined a case of septic arthritis with a positive synovial fluid culture or a synovial fluid white blood cell count of 50,000 or greater per high powered field with a positive blood culture and Lyme arthritis with a positive or equivocal C6 EIA, followed by a positive supplemental immunoblot. Other children were classified as having inflammatory arthritis. We report the performance of the septic arthritis clinical prediction rule in our study population. RESULTS: Of the 543 eligible children, 13 had septic arthritis (2.4%), 234 Lyme arthritis (43.1%), and 296 inflammatory arthritis (54.5%). Of the 457 children (84.2%) with available laboratory predictors, all children with septic arthritis were classified as high risk (sensitivity, 100%; 95% confidence interval [CI], 77.2%-100%; specificity, 68.1%; 95% CI, 63.6-73.3; negative predictive value, 278/278 [100%]; 95% CI, 98.6%-100%). Of the 303 low-risk children, 52 (17.2%) underwent diagnostic arthrocentesis. CONCLUSIONS: The septic knee arthritis clinical prediction rule accurately distinguished between septic and Lyme arthritis in an endemic area. Clinical application may reduce unnecessary invasive diagnostic procedures.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de Lyme / Artritis Infecciosa Tipo de estudio: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Pediatr Emerg Care Asunto de la revista: MEDICINA DE EMERGENCIA / PEDIATRIA Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de Lyme / Artritis Infecciosa Tipo de estudio: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Pediatr Emerg Care Asunto de la revista: MEDICINA DE EMERGENCIA / PEDIATRIA Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos