A guideline for differential diagnosis between septic arthritis and transient synovitis in the ED: a Delphi survey

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• 作者：Jin Hee Lee ; MD^b ; Moon Seok Park ; MD ; PhD^c ; Hyuksool Kwon ; MD^a ; ^{jinuking3g@naver.com" class="auth_mail" title="E-mail the corresponding author} ; Chin Youb Chung ; MD ; PhD^c ; Kyoung Min Lee ; MD PhD^b ; Yu Jin Kim ; MD ; PhD^a ; Kyuseok Kim ; MD ; PhD^a
• 刊名：The American Journal of Emergency Medicine
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：34
• 期：8
• 页码：1631-1636
• 全文大小：573 K

文摘

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.