Jin Hee Lee1, Moon Seok Park2, Hyuksool Kwon3, Chin Youb Chung2, Kyoung Min Lee1, Yu Jin Kim4, Kyuseok Kim4. 1. Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea. 2. Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. 3. Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. Electronic address: jinuking3g@naver.com. 4. Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Abstract
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.
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.
Authors: Atul Mehta; David J Kuter; Sam S Salek; Nadia Belmatoug; Bruno Bembi; Jeremy Bright; Stephan Vom Dahl; Federica Deodato; Maja Di Rocco; Ozlem Göker-Alpan; Derralynn A Hughes; Elena A Lukina; Maciej Machaczka; Eugen Mengel; Aabha Nagral; Kimitoshi Nakamura; Aya Narita; Beatriz Oliveri; Gregory Pastores; Jordi Pérez-López; Uma Ramaswami; Ida V Schwartz; Jeff Szer; Neal J Weinreb; Ari Zimran Journal: Intern Med J Date: 2019-05 Impact factor: 2.048