title: The limping child: an algorithm to outrule musculoskeletal sepsis.
abstract: BACKGROUND
  The acutely limping child presents a significant diagnostic challenge.
  
  
  OBJECTIVE
  The purpose of this study was to create a clinically useful algorithm to allow exclusion of 'musculoskeletal sepsis' as a differential diagnosis in the child presenting with limp.
  
  
  METHODS
  Data were collected on all 286 limping children admitted to our centre over a 3-year-period. Using logistic regression analysis, the predictive model was constructed, to exclude infection.
  
  
  RESULTS
  Duration of symptoms, constitutional symptoms, temperature, white cell count and ESR were significantly different in children with musculoskeletal infection (P < 0.05). Multivariate analysis demonstrated that when all three variables of duration of symptoms >1, <5 days; temperature >37.0 degrees C; and ESR >35 mm/h were present, the predicted probability of infection was 0.66, falling to 0.01 when none were present.
  
  
  CONCLUSIONS
  This multivariate model enables us to rule out musculoskeletal infection with 99% certainty in limping children with none of these three presenting variables.
authors.affiliation: Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland. Delaney.ruth@gmail.com
authors.forename: R A
authors.initials: RA
authors.lastname: Delaney
authors.forename: B
authors.initials: B
authors.lastname: Lenehan
authors.forename: L
authors.initials: L
authors.lastname: O'sullivan
authors.forename: A J
authors.initials: AJ
authors.lastname: McGuinness
authors.forename: J T
authors.initials: JT
authors.lastname: Street
mesh_terms: D000465:Algorithms; D001170:Arthritis, Infectious / Q000175:diagnosis; D001850:Bone Diseases, Infectious / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009135:Muscular Diseases / Q000175:diagnosis*; D010019:Osteomyelitis / Q000175:diagnosis
chemical_list: D002097:C-Reactive Protein