ED Pathway for the Evaluation/Treatment of the Child with Suspected Septic Arthritis

Complete History & Physical

History
Pain
  • Duration, location, single or multiple joints
  • Hip pathology may present as thigh pain
  • Limp vs. refusal to bear weight
  • Quality
    • Increasing in severity
    • Waxing, waning over time
    • Awakens the patient from sleep
    • Worse in the morning
Associated Symptoms
  • Fever
  • Rash
  • Recent, concurrent infectious symptoms
  • Recent wound, trauma at affected joint
Trauma
  • Timing
  • Mechanism
Past Medical History
  • Recent antibiotic use
  • Possible exposure to Lyme
  • Recent immunization
  • LMP for post-pubertal girls
  • Sexual activity
  • History of previous arthritis
  • History of/suggestive of chronic disease
  • Sickle cell disease
Physical Examination
General
  • VS
  • Rash
  • Wound
Joint
  • Swelling
  • Erythema
  • Warmth
  • Tenderness
  • Limited range of motion
  • Pain with micromotion
Ambulation
  • Limp
  • Inability to bear weight