The limping child: an algorithm to outrule musculoskeletal sepsis.
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.
Delaney
R A
RA
Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland. Delaney.ruth@gmail.com
Lenehan
B
B
O'sullivan
L
L
McGuinness
A J
AJ
Street
J T
JT
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
D002097:C-Reactive Protein