A guideline for differential diagnosis between septic arthritis and transient synovitis in the ED: a Delphi survey - 25/07/16
, Chin Youb Chung, MD, PhD c, Kyoung Min Lee, MD PhD b, Yu Jin Kim, MD, PhD a, Kyuseok Kim, MD, PhD aAbstract |
Objective |
Among the causes of limping gait in children, septic arthritis (SA) and transient synovitis (TS) are the 2 most likely etiologies. The aim of this study was to determine the medical histories, physical examinations, and other studies to use to create a clinical guideline for differential diagnosis between SA and TS in children in the emergency department (ED). The pediatric orthopedic emergency committee of our institution addressed the issue of developing a guideline for differential diagnosis.
Methods |
Two rounds of the modified Delphi survey were conducted, and a face-to-face committee meeting was held after each survey round. Delphi survey panelists included 10 pediatric orthopedic surgeons and 8 emergency physicians including 3 pediatric emergency physicians.
Results |
Response rates were 100% in each round. The panelists used a 6-point Likert scale to rate the clinical diagnostic guideline contents as having high (5 or 6), moderate (3 or 4), or low importance (1 or 2). Twenty-eight questionnaire items were included in the first round; and 18 items, in the second round. Factors for concern were selected, and a flowchart of the diagnostic guideline development process was based on the results of the survey.
Conclusion |
A diagnostic guideline for evaluating SA and TS in children in the ED was achieved using combined empirical evidence together with expert opinion, potentially resulting in a diagnostic strategy to be incorporated into existing guidelines or used on its own.
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| ☆ | Funding source: The authors have no financial relationships relevant to this article to disclose. |
| ☆☆ | Financial disclosure: The authors have nothing to disclose. |
| ★ | Conflict of interest: The authors have no conflicts of interest to disclose. |
| ★★ | Clinical trial registration: Not associated. |
| ☆☆☆ | Contributors' statement: Jin Hee Lee and Moon Seok Park equally conceptualized and designed the study and drafted the initial manuscript and approved the final manuscript as submitted. |
| ★★★ | What is known on this subject: Differential diagnosis of septic arthritis and transient synovitis in children in the ED is difficult and requires invasive procedures such as arthrocentesis. |
| ☆☆☆☆ | What this study adds: We developed a diagnostic guideline for evaluating septic arthritis and transient synovitis in children in the ED using the modified Delphi method, which may be useful in the diagnostic strategy either combined with existing guidelines or on its own. |
Vol 34 - N° 8
P. 1631-1636 - août 2016 Retour au numéro
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