Wide variability in diagnosis, treatment of pediatric septic hips found among POSNA members

ORLANDO, Fla. — Among members of the Pediatric Orthopaedic Society of North America, there is a wide variability regarding the diagnosis and treatment of pediatric septic hips, according to results presented here.

“Standardized guidelines may lead to improved quality and safety, as well as potential cost savings and value, in evaluating and treating pediatric septic hips,” Joshua M. Abzug, MD, said in his presentation.

Overall, 322 members of the Pediatric Orthopaedics Society of North America (POSNA) completed a standardized questionnaire composed of 14 questions regarding the work-up and treatment of patients with a potential pediatric septic hip.

According to Abzug, while nearly all responders agreed complete blood count, erythrocyte sedimentation rate and C-reactive protein should be obtained in the emergency department to aid in the clinical decision-making process, three-quarters of respondents routinely obtained blood cultures. He noted approximately 70% of respondents obtained ultrasound, and almost a quarter obtained MRI either with or without contrast.

“When asked who performs the ultrasound, nearly half of the respondents had an ultrasound technologist in house,” Abzug said. “What is interesting, despite the push in our current society in POSNA as well as AAOS, [is] less than 1% of us perform the ultrasound ourselves.”

Regarding MRI, he noted nearly half of the respondents had an MRI technologist in-house and a quarter of respondents would order the MRI overnight and perform MRI the next day.

“If a septic hip was suspected at 1 a.m., about half of us would go in and take care of that while the other half would wait until the next morning,” Abzug said.

When a patient presented with one Kocher criteria, 60% of respondents would obtain additional imaging and 20% would obtain additional labs, Abzug noted. Results showed when the patient had a fever, 70% of respondents would obtain imaging and 20% would obtain additional labs. According to Abzug, about 10% of respondents would go directly to the OR if a patient had three Kocher criteria, while 25% of respondents would go to the OR if a patient had all four Kocher criteria. – by Casey Tingle

Reference:

Abzug JM, et al. Paper #638. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 1-5, 2016; Orlando, Fla.

Disclosure: Abzug is a paid consultant for Axogen; is a paid presenter or speaker for Checkpoint Surgical; and receives publishing royalties, financial or material support from Springer.