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Kocher Criteria for Septic Arthritis

Calculators  Infectious Diseases
Kocher criteria distinguishes septic arthritis from transient synovitis in a child with an inflamed hip.
Non weight-bearing
No 0
Yes 1
Temp > 38.5°C / 101.3°F
No 0
Yes 1
ESR > 40mm/hr
No 0
Yes 1
WBC > 12,000 cells/mm3
No 0
Yes 1
Result:

Background

Measured Factor
Septic arthritis
Measured Factor Disease
  • Septic arthritis
  • Transient synovitis
Measured Factor Detail
Kocher Criteria can be applied to all pediatric patients with an acutely irritable hip who has septic arthritis and transient synovitis are in the differential diagnosis.
Speciality
Orthopedic Surgeon
Body System
Infectious Diseases
Measured Factor High Impact
  • A + 1 criterion shows 3% probability for septic arthritis
  • A + 2 criteria indicated 40% probability for septic arthritis
  • A + 3 criteria showed 93% probability for septic arthritis
  • A + 4 criteria showed 99.6% probability for septic arthritis

Result Interpretation

Ranges Ranges

Studies

Study Validation 1
A prospective study was conducted on children with an acutely irritable hip between 1997 and 2002 to validate the clinical prediction rule for differentiating between septic arthritis and transient synovitis of the hip. On univariate analysis, significant (p <0.05) differences were found between the group with transient synovitis and the group with septic arthritis. In the current patient population, four independent predictors of septic arthritis of the hip were determined included a non-weight-bearing, history of fever, a serum white blood cell count of >12,000 cells/mm(3), and an erythrocyte sedimentation rate of 40 mm/hr. The area under the receiver operating characteristic curve was assessed and observed 0.86 compared with the original population. The study concluded that the prior clinical prediction rule for the differentiation between transient synovitis and septic arthritis of the hip in children was diminished.
References: 2
Study Validation 2
A study was conducted on children with a proven effusion on hip ultrasound and a presentation of ‘atraumatic limp’ between 2004 and 2009, to determine the efficacy of Kocher's criteria to differentiate between septic arthritis and transient synovitis in children. Four variables were taken into consideration included, white blood cell count >12,000 cells/m3, weight-bearing status, temperature >38.5°C and C-reactive protein >20mg/L. According to the results of the study, it was depicted that CRP was a valid independent predictor of septic arthritis with a specificity of 96.8%, a sensitivity of 75.9%, a negative predictive value of 97.5 %, and a positive predictive value of 71.0%.
References: 3
Study Validation 3
A retrospective review was conducted on children who had undergone a hip arthrocentesis between 1992 and 2000, to identify the predictive value and differentiate between transient synovitis and septic arthritis of the hip in children with clinical prediction algorithms. Patients with transient synovitis (118 hips) differed significantly from patients with septic arthritis (true and presumed; forty-seven hips) (p < 0.05). The results of the study described by Kocher et al. depicted that the predicted probability of the patient having septic arthritis was based on three variables: a serum total white blood cell count of >12000/mm(3) (>12.0 x 10(9)/L), a previous health-care visit, and a history of fever and found to be 71%.
References: 4
Study Additional 1
The study was conducted to assess the patient factors and laboratory parameters related to the diagnosis of septic arthritis in adults. By using synovial white blood cell (WBC) counts, the receiver operating characteristic curves were evaluated and the observed significant area under the curve was found to be 0.66 (P=.02). A WBC cutoff of approximately 64,000 cells/µL was needed to achieve 90% specificity with a corresponding sensitivity of 40%. The results of the study depicted the little utility in the Kocher criteria for adult patients, and serum laboratory values usually were elevated nonspecifically.
References: 5
Study Additional 2
A retrospective study was conducted from 2008 to 2015 with an average age of 5 years, including four patients with septic arthritis of the shoulder. The average time for diagnosis was 7 days. Three out of 4 patients showed elevated C-reactive protein (CRP) levels and the erythrocyte sedimentation rate (ESR) was observed with an average of 66 mm/hr. The white blood cell count was reported with an average of 20.2 × 10(3)/mcL.
References: 6
Study Additional 3
The study was conducted and reviewed to determine the predictive value and apply the clinical algorithm to differentiate between septic arthritis and transient synovitis of the hip in children. Clinical prediction algorithms were developed by Kocher et al. and based on four clinical variables: non-weight-bearing, history of fever, a serum white blood-cell count of (>12.0 x 10(9)/L), and an erythrocyte sedimentation rate of >or=40 mm/hr. The predicted probability was observed 59% in patients with septic arthritis, in comparison to  99.6% predicted probability in the patient population who had undergone a hip arthrocentesis.
References: 4

References

  1. Kocher MS, Zurakowski D, Kasser JR. 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.
  2. 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;86-A(8):1629-35.
  3. Singhal R, Perry DC, Bruce CE. THE DIAGNOSTIC UTILITY OF KOCHER'S CRITERIA IN THE DIAGNOSIS OF SEPTIC ARTHRITIS IN CHILDREN: AN EXTERNAL VALIDATION STUDY. The British Editorial Society of Bone & Joint Surgery. InOrthopaedic Proceedings 2012 Jul (Vol. 94, No. SUPP_XXXV, pp. 6-6).
  4. Luhmann SJ, Jones A, Schootman M, Gordon JE, Schoenecker PL, Luhmann JD. Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithms. J Bone Joint Surg Am. 2004;86-A(5):956-62.
  5. Borzio R, Mulchandani N, Pivec R, Kapadia BH, Leven D, Harwin SF, et al. Predictors of Septic Arthritis in the Adult Population. Orthopedics. 2016;39(4):e657-63.
  6. Walker JW, Hennrikus WL. Septic Arthritis of the Pediatric Shoulder: From Infancy to Adolescence. Int J Pediatr. 2016;2016:3086019.