A guideline for differential diagnosis between septic arthritis and transient synovitis in the ED: a Delphi survey

Am J Emerg Med. 2016 Aug;34(8):1631-6. doi: 10.1016/j.ajem.2016.06.006. Epub 2016 Jun 7.


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.

Conclusion: 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.

MeSH terms

  • Acute Disease
  • Arthritis, Infectious / diagnosis*
  • Child
  • Delphi Technique*
  • Diagnosis, Differential
  • Emergency Service, Hospital / standards*
  • Female
  • Humans
  • Male
  • Practice Guidelines as Topic*
  • Surveys and Questionnaires*
  • Synovitis / diagnosis*