A guideline for differential diagnosis between septic arthritis and transient synovitis in the ED: a Delphi survey.
OBJECTIVE
Among the causes of limping gait in children, septic arthritis (SA) and transient synovitis (TS) are the 2 most likely etiologies. The aim of this study was to determine the medical histories, physical examinations, and other studies to use to create a clinical guideline for differential diagnosis between SA and TS in children in the emergency department (ED). The pediatric orthopedic emergency committee of our institution addressed the issue of developing a guideline for differential diagnosis.


METHODS
Two rounds of the modified Delphi survey were conducted, and a face-to-face committee meeting was held after each survey round. Delphi survey panelists included 10 pediatric orthopedic surgeons and 8 emergency physicians including 3 pediatric emergency physicians.


RESULTS
Response rates were 100% in each round. The panelists used a 6-point Likert scale to rate the clinical diagnostic guideline contents as having high (5 or 6), moderate (3 or 4), or low importance (1 or 2). Twenty-eight questionnaire items were included in the first round; and 18 items, in the second round. Factors for concern were selected, and a flowchart of the diagnostic guideline development process was based on the results of the survey.


CONCLUSIONS
A diagnostic guideline for evaluating SA and TS in children in the ED was achieved using combined empirical evidence together with expert opinion, potentially resulting in a diagnostic strategy to be incorporated into existing guidelines or used on its own.
Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea.
Jin Hee
JH
Lee
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Moon Seok
MS
Park
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. Electronic address: jinuking3g@naver.com.
Hyuksool
H
Kwon
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Chin Youb
CY
Chung
Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea.
Kyoung Min
KM
Lee
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Yu Jin
YJ
Kim
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Kyuseok
K
Kim
D000208:Acute Disease; D001170:Arthritis, Infectious / Q000175:diagnosis*; D002648:Child; D003697:Delphi Technique; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013585:Synovitis / Q000175:diagnosis*