Sensitivity of erythrocyte sedimentation rate and C-reactive protein for the exclusion of septic arthritis in emergency department patients

The Journal of Emergency Medicine
Praveen Hariharan, Christopher Kabrhel

Abstract

Previous studies in post-operative orthopedic and pediatric patients suggest that erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) testing may be helpful in ruling out septic arthritis. However, these tests have not been evaluated in a population of adult Emergency Department (ED) patients. Determine the sensitivity of ESR and CRP in patients with septic arthritis. Retrospective analysis of ED patients with septic arthritis from 2003 to 2008. Eligible patients had an International Classification of Diseases-Ninth Revision diagnosis of pyogenic arthritis (711.0x) plus: positive synovial fluid culture, positive synovial Gram stain, or operative irrigation. Patients were excluded if no ESR or CRP was performed within 24 h. Sensitivity of ESR and CRP at various cutoffs was calculated with 95% confidence intervals (CI). We identified 167 patients with septic arthritis. We included 143 (86%) who had ESR (n=140, 84%) or CRP (n=96, 57%) performed. Mean age was 49 (± 22) years, and 85 (59%) were male. Race was: 125 (87%) white, 4 (3%) black, and 12 (8%) Hispanic. Thirty-five (24%) had infection of prosthetic joints. Synovial cultures were positive in 102 (71%). Sensitivity of ESR was: 98% (95% CI 94-100%) using a cutoff...Continue Reading

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Citations

Feb 6, 2014·International Orthopaedics·Gregory CunninghamIlker Uçkay
Jun 25, 2014·Joint, Bone, Spine : Revue Du Rhumatisme·Jean-Jacques DubostMartin Soubrier
Nov 12, 2013·The Journal of Hand Surgery·Gavin B BishopAndrew Jawa
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Jan 17, 2021·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Eun-Seok ChoiHyun Dae Shin

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