INTRODUCTION: Septic arthritis (SA) is a serious orthopedic emergency. Waiting for aspiration and microbiological analysis results may cause therapeutic delay, resulting worsening of prognosis. In this study, it was aimed to determine the predictive value of clinical signs, laboratory and radiological examinations for the diagnosis of culture-proven SA and SA agents, and to create projections for early treatment.
METHODS: This 7-year retrospective cohort study included adult patients with suspected SA seen in a tertiary hospital emergency department. Patients with a positive culture aspiration confirming septic arthritis at one joint were analyzed, and then compared to a control group defined as 'Aseptic Arthritis' (ASA).
RESULTS: While Acute onset (P=0.038), history of crystal-induced arthritis (P=0.022) were significantly higher in the aseptic arthritis group, the presence of pain increasing with movement (P=0.042), previous septic arthritis history (P=0.028), higher than 0.5 ng/mL serum procalcitonin value (P=0.048), purulent appearance of synovial fluid (P=0.028) were found to be significantly higher in the septic arthritis group. However, septic arthritis patients significantly had a synovial fluid WBC count of over 20,000/μL and a PMNs ratio of over 75%. Pain that increases with movement Methicillin-resistant S. aureus was highly effective in differentiating from other bacteria (sensitivity 100, P=0.048).
DISCUSSION AND CONCLUSION: Although the definition of SA or its diagnostic criteria have not yet been determined, a few factors we found in our study results, the cutoff values we suggested, and the definition of “Aseptic Arthritis” that we used in our study design may be thought-provoking in terms of determining the diagnostic criteria for SA.