ED Pathway for the Evaluation/Treatment of the Child with
Suspected Septic Arthritis
HIP JOINT
KNEE JOINT
 
 
 
High Probability
Septic Arthritis
Fever ≥ 38°
Pain with micromotion
Refusal to bear weight
Labs, X-rays,
US, Analgesia
Ortho Consult 1 hr
US
+
-
Effusion
Effusion
Joint Aspiration
IV Antibiotics
Admit Ortho*
OR
Admit
Pediatrics
Equivocal
Septic Arthritis
Afebrile
Decreased Range of Motion
Limp
Labs, X-rays
+
-
+
-
 
US
 
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
Labs, X-rays
Joint Aspiration
+
-
 
IV Antibiotics
Ortho Consult
Admit Ortho*
OR
Consider
admission
for other
work-up
Equivocal
Septic Arthritis
Afebrile
Pain less severe
Labs, X-rays
+
-
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: January 2016, February 2017, November 2017
Authors: P. Aronson, MD, J. Posner, MD, S. Dooley, RN, S. Coffin, MD, C. Jacobstein, MD, J. Lavelle, MD