Kocher Criteria for Septic Arthritis Distinguishes septic arthritis from transient synovitis in a child with an inflamed hip However, an area under the curve of 0.86 still shows very good diagnostic performance for a predictive test and because of this, many EM physicians and orthopedic surgeons still use the Kocher criteria for septic arthritis today
then the ankle. Together these threesites account for 80% of all cases. In addition to the Kocher criteria,other signs of septic arthritis are limbpain, joint effusion, and a strong ten-dency for the patient to hold the af-fected joint in the position of maximalintracapsular volume to minimize dis-comfort. Neonates and infants may pre-sent with pseudoparalysis in responseto the joint pain The Kocher score was retrospectively derived by Kocher et al. in 1999 as a way to help clinicians differentiate between septic arthritis and transient tenosynovitis in pediatric patients with inflamed hips. The original study included 282 patients of which 82 were eventually diagnosed with septic arthritis based on joint fluid analysis
The Kocher criteria for septic arthritis has proved its specificity in diagnosing or ruling out SA for the extreme scores The Kocher criteria for septic arthritis calculator uses the original 4 criteria in the model, with yes or no answers as described below: ■ Non weight-bearing - this is one of the main suspicion signs of septic arthritis in children who experience a painful joint that they do not want to bear weight on that side , a patient with 0 of 4 Kocher criteria, a negative CRP, and a low pre-test probability of septic arthritis can reasonably be managed as an outpatient with NSAIDS and strict return precautions for worsening hip pain and/or fever A total of 458 knee aspirates for suspected septic arthritis were evaluated with serum and synovial leukocyte counts and differentials as well as Kocher criteria for pediatric septic arthritis. Twenty-two patients (4.8%) had septic arthritis confirmed by a positive synovial fluid culture Caird et.al. (2006) added CRP to the Kocher criteria. CRP ≥ 20 mg/L is another predictor of septic arthritis. The best predictor of septic arthritis is fever followed closely by raised CRP. A study by Walker et.al. revealed that an elevated CRP (2.0mg/dL) and inability to bear weight together resulted in a PPV of 78%
Hip Septic Arthritis - Pediatric. Pediatric Septic Hip Arthritis is an intra-articular infection in children that peaks in the first few years of life. While diagnosis may be suspected by a combination of history, physical exam, imaging, and laboratory studies, confirmation requires a hip aspiration Kocher criteria From Wikipedia, the free encyclopedia The Kocher criteria are a tool useful in the differentiation of septic arthritis from transient synovitis in the child with a painful hip. They are named for Mininder S. Kocher, an orthopaedic surgeon at Boston Children's Hospital and Professor of Orthopaedic Surgery at Harvard Medical School
Diagnoses of true septic arthritis, presumed septic arthritis, and transient synovitis were explicitly defined on the basis of the white blood-cell count in the joint fluid, the results of cultures of joint fluid and blood, and the clinical course. Univariate analysis and multiple logistic regression analysis were used to compare groups • The Kocher criteria were derived to identify the variables that are important in distinguish-ing between septic arthritis (SA) and transient synovitis (TS). • In the appropriate clinical setting, patients who fall on either probability extreme (0 criteria or 4 criteria) can be readily ruled in or out for SA The Kocher criteria for septic arthritis calculator uses the original 4 criteria in the model, with yes or no answers as described below: Non weight-bearing - this is one of the main suspicion signs of septic arthritis in children who experience a painful joint that they do not want to bear weight on that side Septic arthritis is a rather rare.
Septic Arthritis: Kocher's Criteria. In 1999, Kocher et al published retrospective data from cases that presented to their facility from 1979-1996 due to acutely irritable hip. Through a logistic regression analysis of 168 patients, they devised a probabilityalgorithm to help differentiate between septic arthritis and toxic synovitis The Kocher Criteria for Septic Arthritis distinguishes septic arthritis from transient synovitis in a child with an inflamed hip. Determine risk of septic arthritis in a child with an inflamed hi Kocher's criteria These are a set of four criteria, which when taken in combination are supposed to indicate the likelihood of septic arthritis in a child. They were originally developed for the hip. One point is given for each of
. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999; 81 (12):1662-70 Kocher criteria have been suggested to predict the diagnosis of septic arthritis in children. Clinical examination of neonates and infants with septic arthritis is particularly difficult because there are usually few or no objective signs to rely upon Purpose: Pediatric septic arthritis of the hip (SAH) remains an emergent condition with significant sequelae if missed in the acute setting. Definitive diagnosis requires an invasive procedure, thus making clinical evaluation and suspicion extremely important. While many algorithms exist to assist in this clinical diagnosis, there is no single agreed upon set of predictive criteria BACKGROUND: Septic arthritis is an emergency. In 1999 Kocher et al. identified four clinical criteria to distinguish hip septic arthritis from transient synovitis in children (nonweightbearing, erythrocyte sedimentation rate ≥ 40 mm/L, white blood cell count > 12 × 10(9)/L, temperature > 38.5°C) Kocher Criteria for Septic Arthritis of the Hip. Temperature > 38.5°C 9/L) Erythrocyte sedimentation rate >40 mm/h Inability to ambulate C-reactive protein >25 mg/dL (2.5 mg/L)* * C-reactive protein not part of the original Kocher criteria. Reprinted with permission from Herman MJ, Martinek M. The limping child
Determine risk of septic arthritis in a child with an inflamed hip Rhabdomyolysis Risk Score Predict the risk of severe acute kidney injury or mortality in patients with rhabdomyolysis Kocher Criteria for Septic Arthritis Determine risk of septic arthritis in a child with an inflamed hip Shock Index A more sensitive quotient for circulatory. The Kocher criteria for septic arthritis are used to distinguish between septic arthritis and transient synovitis in a child with an in amed hip. Discover the world's research 20+ million member The Kocher criteria are established clinical parameters that predict hip septic arthritis (SA) with a 93% or greater positive-predictive value when 3 or 4 variables are present. The incidence of osteomyelitis (OM) in these patients has not been reported. The purpose of this study is to evaluate the incidence of OM in patients who have 3 or 4. Addition of nCD64 count in Kocher's criteria had increase their sensitivity, specificity and AUC from 0.30, 0.62 and 0.57 to 0.65, 0.93 and 0.95 respectively. Conclusion: The CD64 count on neutrophils (nCD64) was the potential diagnostic test for septic arthritis and addition of nCD64 count in Kocher's criteria may increase its reliability The Kocher criteria incorporates both ESR and serum WBC levels and predicts that septic arthritis can be excluded in the absence of four criteria (non-weight bearing, ESR > 40, serum WBC >12K, and fever) (7). In addition, Paakkonen et al. reported sensitivities of 94 and 95% for ESR and CRP levels respectively and a combined sensitivity of 98%.
The Kocher criteria consist of 4 high-risk predictors of septic arthritis: fever >38.5°C, inability to bear weight on the affected joint, serum WBC ≥12 000 × 10 3 cells per mL, and an erythrocyte sedimentation rate ≥40 mm/hour. 7 They were originally developed to differentiate septic arthritis from transient synovitis in children. Kocher criteria: ↑ likelihood for hip septic arthritis over transient synovitis with ↑ number of predictors Fever > 38.5°C, non-weight-bearing, WBC > 12 × 10⁹ cells/L, ESR ≥ 40 mm/hour; later addition to original criteria: CRP > 20 mg/L - With all present, specificity for septic arthritis ∼ 60-99% Best predictors: Fever, ↑ CR
Kocher Criteria Original Derivation Study, 1999: Retrospective chart review of 282 patients evaluated between 1979 and 1996 at a major tertiary-care children's hospital presenting with an acutely irritable hip. Final diagnoses included confirmed septic arthritis, presumed septic arthritis, and transient synovitis Septic arthritis is an orthopaedic emergency which requires timely management to prevent joint destruction and poor outcome. Differentiating septic arthritis from transient synovitis in pediatric patients is aided by the use of Kocher criteria which have excellent sensitivity but lack specificity Conclusions: According to the Kocher criteria of the hip, at 3 or more criteria the probability of septic arthritis becomes 93% with a sensitivity of 0.84 provoking many physicians to use this. Overview. Pediatric septic hip arthritis is a n intra-articular infection in children that peaks in the first few years of life. Diagnosis involves a combination of elevation of infectious labs, limited hip motion on exam, hip effusion on focused imaging (MRI and Ultrasound) and elevated synovial WBC on hip aspiration
The Kocher criteria for predicting septic arthritis gives increasing probability for each of the following criteria met [Kocher et al. J Bone Joint Surg-Am] 2004:86;1629. Non-weight-bearing on affect side; ESR > 40 mm/hr; Fever; WBC >12,000; The Kocher rule is helpful to rule-in higher pre-test probability patients. Fever is probably the best. Kocher's criteria for differentiating a septic hip have been applied at other institutions with variable results. 2, 3, 4 This has led authors to conclude that using a clinical prediction algorithm to differentiate between septic arthritis and transient synovitis has improved overall care for children. Despite these excellent prediction rules.
. It can present as a polyarticular arthropathy (~15% of cases), 2,3 but a monoarthropathy of the hip, knee, or ankle is more common. 4 The Kocher criteria are often applied to cases of suspected septic arthritis of joints,. Kocher Criteria. In their original paper in 1999, Dr Kocher et al. performed a retrospective analysis of children who were being evaluated for a septic joint versus transient synovitis over a 15 year period, in a major referral center. They came up with four independent predictors of a septic joint, and calculated the probability of septic. Septic arthritis is one of the important differentials for a red, hot and swollen joint. It is an inflammatory condition of the joint caused by bacterial infection. Septic arthritis can be caused by direct inoculation of the joint or by haematogenous spread of bacteria from another site The Kocher Criteria for diagnosing septic arthritis of the hip can be used to determine if an aggressive approach to management of the patient should be started. The four criteria used in order of sensitivity in the Kocher criteria are, fever higher than 38.5 C (101.3 F), ESR more than 40 According to the Kocher criteria of the hip, at 3 or more criteria the probability of septic arthritis becomes 93% with a sensitivity of 0.84 provoking many physicians to use this cutoff in their assessment of hip pain. This study suggests that if these criteria were applied to the knee, 52% of septic knee cases could be missed
Kocher MS et al. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999 Dec;81(12):1662-70 The Kocher criteria are a tool useful in the differentiation of septic arthritis from transient synovitis in the child with a painful hip. They are named for Mininder S. Kocher, an orthopaedic surgeon at Boston Children's Hospital and Professor of Orthopaedic Surgery at Harvard Medical School.. The original study used retrospective pediatric cases to develop the criteria over multiple years Background:The early diagnosis of pediatric septic arthritis is paramount to the prevention of long-term sequela. The purpose of this study is to investigate if the commonly used criteria developed by Kocher and colleagues for hip septic arthritis can be used for screening children with suspected septic knee.Methods:We retrospectively reviewed the charts of patients under the age of 19. Kocher criteria: ↑ likelihood for septic arthritis over transient synovitis with ↑ number of positive parameters Fever, non-weight-bearing, ↑ WBC, ↑ ESR • Transient synovitis self-limited, lasting 7-10 days • Conservative management with bed rest + NSAIDs Hip aspiration expedites clinical improvemen
Septic arthritis is synonymous with an infection in a joint. Septic arthritis is usually caused by bacteria but can also be caused by other microorganisms. Septic arthritis due to bacterial infection is often a destructive form of acute arthritis [ 1 ]. The epidemiology, microbiology, clinical manifestations, diagnosis, differential diagnosis. Septic arthritis (SA) is an important diagnostic consideration in patients who present to the emergency department with atraumatic hip pain. We utilized the original Kocher criteria plus C‐reactive protein (CRP) for laboratory data analysis. Medical record review and data abstraction of each patient was performed independently by 2. Kocher criteria re: septic arthritis) • Follow-up: Amber Action: Age Less than 3 Years: Age 3 - 10 years Older than 10 years: Any Age Septic arthritis (SA)/ osteomyelitis (OM) • Usually febrile. • Most commonly occurs under 4 years of age. • Pain + inability to bear weight Kocher Criteria - used to identify septic hip arthritis vs. transient synovitis Refusal to bear weight; ESR >40 mm/h; Fever >38.5°C; WBC >12,000 cells/uL; CRP >20 mg/L or >2mg/dL (not part of original criteria, but shown to be most reliable indicator 9. Horowitz DL, Katzap E, Horowitz S, Barilla-LaBarca ML. Approach to septic arthritis. Am Fam Physician. 2011;84(6):653-660. 10. Hwang C. Calculated decisions: Kocher criteria for septic arthritis. Pediatr Emerg Med Pract. 2019;16(12):CD1-CD2. 11. Uzoigwe CE. Another look: is there a flaw to current hip septic arthritis diagnostic algorithms
Septic arthritis, also known as joint infection or infectious arthritis, is the invasion of a joint by an infectious agent resulting in joint inflammation. Symptoms typically include redness, In children, the Kocher criteria is used for diagnosis of septic arthritis Kocher Criteria for Septic Arthritis Work-up: Kocher 2 or Higher Assign 1 point each: Non-weight bearing Joint aspirate as soon as feasible Temperature >38.5 C ESR >40mm/hr (or CRP >2.0 mg/dL) Peripheral WBC >12,000 cells/mm3 Risk for Score: 1 = 3%, 2 = 40%, 3 = 93%, 4 = 99 Mininder S. Kocher, M.D., and his associates did a retrospective study of children with acutely irritable hip and concluded that four predictors—the white blood cell count and sedimentation rate cited by Dr. Pizzutillo, fever, and the inability to bear weight—could be used to differentiate septic arthritis from transient synovitis of the hip Kocher et al. , performed a retrospective study using four clinical predictors to differentiate between septic arthritis and transient synovitis: fever ≥ 38.5°C, mm. 3. These authors found that the predicted probability for septic arthritis in case all four predictors are positive is 99.6%.. Kocher criteria: (for child with painful hip)- includes: non-weight-bearing on affect side,sed rate greater than 40 mm/hr, fever, and aWBC count of >12,000 mm3;- when 4/4 criteria are met, there is a99% chance that the child has septic arthritis; - when 3/4 criteria are met, there is a93% chance of septic arthritis; - when 2/4 criteria are met.
Septic arthritis of the sacroiliac joint is a relatively rare disorder, affecting between 1% and 2% of all patients with septic arthritis. KOCHER CRITERIA Kocker et al in 1999: the presence or absence of the above 4 clinical predictors could be used to accurately predict the likelihood of a septic hip in a child with limp. 32 The Kocher criteria were developed as a joint-specific algorithm for the diagnosis of septic arthritis of the pediatric hip and have facilitated in the diagnosis of septic hips . Joint insensitive clinical algorithms do exist for the diagnosis of septic arthritis [ 16 , 17 ]
Orthop Clin North Am. 2017 Apr;48(2):209-216; John J, Chandran L. Arthritis in children and adolescents The Kocher criteria consist of 4 high-risk predictors of septic arthritis: fever >38.5°C, inability to bear weight on the affected joint, serum WBC ≥12 000 × 10 3 cells per mL, and an erythrocyte sedimentation rate ≥40 mm/hour. 7 They. - Kocher criteria: (for child with painful hip) there is a 99% chance that the child has septic arthritis; - when 3/4 criteria are met, there is a 93% chance of septic arthritis; - septic arthritis of hip may lead to dislocation, subluxation, dysplasia,. However, a 2010 study reported a postive predictive value of only 59% when all 5 criteria were positive. Another prospective found fever (an oral temperature >38.5 degrees C) was the best predictor of septic arthritis followed by an elevated C-reactive protein level (levels >20mg/L), an elevated erythrocyte sedimentation rate, refusal to bear weight, and an elevated serum white blood-cell count The Kocher criteria confer a predictive value of 99.6% when all conditions are met. While C albicans is not a common cause of septic arthritis, reports indicate higher risk in immune compromised patients such as those with rheumatic conditions, on steroid therapy and particularly when they also have diabetes Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 2004 Aug. 86-A (8):1629-35. Thus, the Kocher criteria are used to help determine the likelihood of septic arthritis versus transient synovitis. In a child with a hip joint effusion, the presence of each of the following clinical parameters increases the likelihood of septic arthritis: 1) fever, 2) non-weight bearing, 3) elevated ESR, and 4) high serum WBC. 1 According to.