Author(s):
De Marco, Giacomo ; Vazquez, Oscar ; Cochard, Blaise ; Foland, Piotr ; Meinzer, Ulrich ; Mallet, Cindy ; Ilharreborde, Brice ; Haumont, Edouard ; Pejin-Arroyo, Zagorka ; Yagupsky, Pablo ; Gené, Amadeu ; Velasco Arnaiz, Eneritz ; Gouveia, Catarina ; Arcangelo, Joana ; Mainard, Nicolas ; Gravel, Jocelyn ; Walls, Tony ; Hagedoorn, Nienke ; Khatami, Ameneh ; Tashani, Mohamed ; Valisena, Silvia ; Steiger, Christina ; Dayer, Romain ; Chargui, Moez ; Alcobendas Rueda, Rosa Maria ; Fernandez-Cooke, Elisa ; Bravo, Beatriz ; Martin Pedraz, Laura ; Murias Loza, Sara ; Clemente, Daniel ; Canavese, Federico ; Ceroni, Dimitri
Date: 2025
Persistent ID: http://hdl.handle.net/10362/191084
Origin: Repositório Institucional da UNL
Subject(s): algorithm; children; hip joint; Kingella kingae; Kocher & Caird criteria; pediatric infections; septic arthritis; Microbiology; Microbiology (medical); Virology
Description
Publisher Copyright: © 2025 by the authors.
In children under 4, septic arthritis of the hip (SAH) caused by Kingella kingae (SAH-KK) can be misdiagnosed, as it does not meet classic septic joint criteria (fever > 38.5°, pain, limited range of motion, and inability to bear weight). The objective of this study was to report clinical and paraclinical characteristics in a large cohort of children with confirmed SAH-KK and to evaluate the reliability of the Kocher (KC) and Caird criteria (CC) in predicting SAH-KK. Medical records of 140 children with confirmed SAH-KK were collected. Data on sex, age, temperature on admission, weight-bearing status, white blood cell (WBC) count, platelet count, C-reactive protein (CRP) value, and erythrocyte sedimentation rate (ESR) were extracted. The study focused on the sensitivity of KC (body temperature, refusal to bear weight, leukocytosis, and ESR) and CC (KC criteria plus CRP level). All patients had bacteriologically confirmed SAH-KK; most had mild symptoms and near-normal inflammatory markers. CRP (76.2%) had the highest sensitivity, followed by weight-bearing status (73.8%) and WBC count (69.6%). Body temperature and ESR exceeded cutoff values in less than 50% of cases. Among 77 patients fulfilling all KC, 49 (63.5%) had less than a 40% probability of SAH. Of 50 children with complete CC, 20 (40%) had a 62.4% or lower probability of SAH. KC and CC are not sufficiently accurate to confidently exclude SAH-KK in preschool-aged children due to heterogeneous clinical presentations. Further studies are needed to redefine diagnostic criteria based on patient age and causative pathogens.
