ED Pathway for the Evaluation/Treatment of the Child with Suspected Septic Arthritis
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HIP JOINT
KNEE JOINT
High Probability
Septic Arthritis
Fever ≥ 38°
Pain with micromotion
Refusal to bear weight
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Labs, Xrays,
US, Analgesia
Ortho Consult 1 hr
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US
+
-
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Effusion
Effusion
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Joint Aspiration
IV Antibiotics
Admit Ortho*
OR
Admit
Pediatrics
Equivocal
Septic Arthritis
Afebrile
Decreased Range of Motion
Limp
Labs, Xrays
+
-
+
-
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US
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Ortho Consult
Consider Aspiration
Consider admit
Pediatrics for
further workup
Discharge
PMD F/U
High Probability
Septic Arthritis
Swelling, erythema
Fever ≥ 38°
Pain with micromotion
Refusal to bear weight
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Labs, Xrays
+
-
Joint Aspiration
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arrow
IV Antibiotics
Ortho Consult
Admit Ortho*
OR
Consider
admission
for other
work-up
Equivocal
Septic Arthritis
Afebrile
Pain less severe
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Labs, Xrays
+
-
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Joint
aspiration,
consider
admit Pediatrics
for further
work-up
Discharge
*Patients with chronic medical conditions should be admitted to Gnl Peds/appropriate subspecialty service.
Posted: July 2010
Revised: October 2011
Authors: P. Aronson, MD, J. Posner, MD, S. Dooley, RN, S. Coffin, MD,
C. Jacobstein, MD, J. Lavelle, MD