Clinical indicators for distinguishing septic arthritis from paediatric transient synovitis of the hip: a systematic review and meta-analysis.

backgroundSeptic arthritis (SA) of the hip joint is a serious infection that can result in irreversible complications. Distinguishing septic arthritis from transient synovitis, the most common cause of hip pain in children, is crucial for preventing severe outcomes. Existing research has primarily focused on identifying clinical signs and laboratory findings that indicate high-risk patients who may need invasive diagnostic procedures; however, results have been inconsistent. This study aims to evaluate the correlation of various clinical indicators in differentiating septic arthritis from pediatric transient synovitis of the hip.

methodsThis study followed the PRISMA guidelines rigorously and was registered with PROSPERO. We conducted a systematic search of PubMed, Embase, and Cochrane Library databases for relevant literature up to September 2024. Studies included in the analysis were required to evaluate the predictive value of clinical indicators distinguishing septic arthritis and transient synovitis of the hip in children under 18 years of age. The risk of bias and quality of the included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and RevMan 5.3. Data synthesis was performed using Stata MP-64 18.0 software to facilitate meta-analysis.

resultsA total of eleven studies were ultimately included for the final analysis, comprising 1810 cases. The results of meta-analysis revealed that history of fever emerged as a significant risk factor for differentiating septic arthritis from pediatric transient synovitis of the hip (OR = 6.04, 95% CI = 2.44-14.97, P < 0.001). Other notable risk factors included non-weight-bearing status (OR = 5.23, 95% CI = 1.38-19.75, P = 0.015), erythrocyte sedimentation rate (OR = 3.98, 95% CI = 1.29-12.30, P = 0.017), and serum white blood cell count (OR = 2.73, 95% CI = 1.23-6.03, P = 0.013). In contrast, C-reactive protein was not a significant risk factor (OR = 7.12, 95% CI = 0.59-85.70, P = 0.122).

conclusionThe clinical indicators involving a history of fever, non-weight-bearing status, erythrocyte sedimentation rate, and serum white blood cell count have been identified as cost-effective routine tests with potential value in differentiating septic arthritis from pediatric transient synovitis of the hip. To enhance the reliability of these findings, further prospective studies are essential. CLINICAL TRIAL NUMBER: Not applicable.