Evidence map›Paper›PMID 32989558›Full record

ArticleInternational orthopaedics2020

A clinical decision tool for septic arthritis in children based on epidemiologic data of atraumatic swollen painful joints in South Africa.

Alex Upfill-Brown, Marie-Fien Bruins, Stewart Dix-Peek, Maritz Laubscher, Nicholas M Bernthal, Michael Held

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Article in International orthopaedics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.4field-weighted citation impact, top 35% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 3 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 2 countries.

Alex Upfill-BrownDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.ORCID 0000-0003-3176-1382
Marie-Fien BruinsOrthopedic Research Unit, Department of Orthopaedic Surgery, Red Cross Children's Hospital, University of Cape Town, 7925 Observatory, Cape Town, South Africa.
Stewart Dix-PeekOrthopedic Research Unit, Department of Orthopaedic Surgery, Red Cross Children's Hospital, University of Cape Town, 7925 Observatory, Cape Town, South Africa.
Maritz LaubscherOrthopedic Research Unit, Department of Orthopaedic Surgery, Red Cross Children's Hospital, University of Cape Town, 7925 Observatory, Cape Town, South Africa.
Nicholas M BernthalDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Michael HeldOrthopedic Research Unit, Department of Orthopaedic Surgery, Red Cross Children's Hospital, University of Cape Town, 7925 Observatory, Cape Town, South Africa. Michael.Held@uct.ac.za.
University of Cape Town · ZAUniversity of California, Los Angeles · US

Funding

NIH HHS NIH RO1 HD058971
6 · The paper itself

Abstract

backgroundIn settings with limited access to specialist services, differentiating septic arthritis-a surgical emergency-from non-infectious atraumatic arthropathy in paediatric patients is challenging, especially in a setting with a high burden of tuberculosis (TB). We aimed to investigate the aetiologies of swollen, painful joints in an urban setting in South Africa and determine how clinical and laboratory findings varied with diagnosis. PATIENTS AND

methodsA retrospective review of patients aged 12 or younger presenting to a paediatric hospital in Cape Town, South Africa, with atraumatic swollen, painful joints was conducted over a two year period from 2013 to 2015. Children were excluded if they did not have tissue culture or analysis conducted at our facility. Aetiology was classified as non-infectious, TB septic arthritis, or pyogenic arthritis from other bacterial causes.

resultsOne hundred and four children met inclusion criteria. Arthritis was classified as non-infectious in 43 (41%), TB in 15 (14%), and pyogenic in 40 (38%), with six (6%) patients never receiving a final diagnosis. Mean C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count (WCC) were all significantly higher in pyogenic infectious arthritis compared with TB and non-infectious arthritis. There were no significant differences in these parameters between non-infectious and TB arthritis. Using cut-point analysis, thresholds were identified predictive of the presence of pyogenic arthritis versus TB or non-infectious arthritis; these included the presence of fever, CRP > 50 mg/L, ESR > 65 mm/h and WCC > 12x10

conclusionsDespite insignificant differences in their clinical presentation compared with non-infectious arthidities, 15% of children were diagnosed with tissue-confirmed TB infection. Predictive values of clinical criteria are reduced in our population due to elevated levels of inflammatory markers in all patients. Synovial biopsy to rule out TB is recommended in all patients in a high-burden setting given clinical similarity to non-infectious aetiologies.

Indexed as

Arthritis, InfectiousBlood SedimentationChildC-Reactive ProteinHumansLeukocyte CountRetrospective StudiesSouth AfricaC-Reactive ProteinInflammatory arthritisPediatric joint infectionSeptic arthritisTuberculosis

Identifiers

PMID32989558
OpenAlexW3091583315

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.