title: Laboratory predictors for risk of revision surgery in pediatric septic arthritis.
abstract: BACKGROUND
  Reported complications of pediatric septic arthritis range from minor growth abnormalities to potentially life-threatening conditions and death; some children require multiple surgeries for eradication of infection. The purpose of this study is: (1) to determine the failure rate of a single surgical incision and drainage (I&D) in pediatric septic arthritis, (2) to identify risk factors for failure which are detectable at the time of initial presentation, and (3) to trend post-operative C-reactive protein (CRP) values to see if there is a difference between children who fail a single I&D and those who do not.
  
  
  METHODS
  The medical records for 105 children who underwent operative management of septic arthritis were retrospectively reviewed. Single and multivariate analyses were performed.
  
  
  RESULTS
  Eighty-four children required one surgical intervention [mean age 5.18 years (±4.01); 38 females (45 %), 46 males (55 %)], 21 children required revision surgery [mean age 8.16 years (±4.54); 4 females (19 %), 17 males (81 %)], and the overall rate of revision surgery was 20 %. Delayed diagnosis (p = 0.015), elevated CRP at presentation (p = 0.000), positive blood culture (p = 0.000), and age (p = 0.009) were all associated with revision surgery in bivariate analysis. In multivariate analysis, CRP at presentation and positive blood culture were significant risk factors for revision surgery (p = 0.005 and p = 0.025, respectively). Additionally, markedly elevated CRP levels on post-operative days (POD) 1-4 were each independently significant risk factors for requiring multiple surgeries (all p < 0.000). Fever, elevated erythrocyte sedimentation rate, and leukocyte count were not risk factors for multiple surgeries.
  
  
  CONCLUSIONS
  In this study, a positive blood culture or marked elevation in CRP at presentation or on POD 1-4 were associated with revision surgery. These findings may help improve surgical planning for both the initial surgery in order to avoid revisions, as well as revision surgery, should it be indicated.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA. Telleria@uw.edu.
authors.forename: Jessica J M
authors.initials: JJ
authors.lastname: Telleria
authors.affiliation: Department of Orthopaedics and Sports Medicine, OA.9.120.1-Orthopedics Administration, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Cotter
authors.affiliation: Department of Orthopaedics and Sports Medicine, OA.9.120.1-Orthopedics Administration, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
authors.forename: Viviana
authors.initials: V
authors.lastname: Bompadre
authors.affiliation: Department of Orthopaedics and Sports Medicine, OA.9.120.1-Orthopedics Administration, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Steinman
keywords: Blood culture; C-reactive protein; Failure; Pediatric; Septic arthritis; Surgery