Emergency Department Clinical Pathway for the Evaluation/Treatment
of Children with Suspected Septic Arthritis
HIP JOINT
KNEE JOINT
High Probability
Septic Arthritis
Septic Arthritis
Fever ≥ 38°
Pain with micromotion
Refusal to bear weight
Pain with micromotion
Refusal to bear weight
Labs, X-rays,
US, Analgesia
Ortho Consult 1 hr
US, Analgesia
Ortho Consult 1 hr
US
+
-
Effusion
Effusion
Joint Aspiration
IV Antibiotics
Admit Ortho*
OR
IV Antibiotics
Admit Ortho*
OR
Admit
Pediatrics
Pediatrics
Equivocal
Septic Arthritis
Septic Arthritis
Afebrile
Decreased Range of Motion
Limp
Decreased Range of Motion
Limp
Labs, X-rays
+
-
+
-
US
Ortho Consult
Consider Aspiration
Consider Aspiration
Consider admit
Pediatrics for
further workup
Pediatrics for
further workup
Discharge
PMD F/U
PMD F/U
High Probability
Septic Arthritis
Septic Arthritis
Swelling, erythema
Fever ≥ 38°
Pain with micromotion
Refusal to bear weight
Fever ≥ 38°
Pain with micromotion
Refusal to bear weight
Labs, X-rays
Joint Aspiration
Joint Aspiration
+
-
IV Antibiotics
Ortho Consult
Admit Ortho*
OR
Ortho Consult
Admit Ortho*
OR
Consider
admission
for other
work-up
admission
for other
work-up
Equivocal
Septic Arthritis
Septic Arthritis
Afebrile
Pain less severe
Pain less severe
Labs, X-rays
+
-
Joint
aspiration,
consider
admit Pediatrics
for further
work-up
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
Last Revised: October 2024
Authors: J. Posner, MD; C. Jacobstein, MD; J. Lavelle, MD
Last Revised: October 2024
Authors: J. Posner, MD; C. Jacobstein, MD; J. Lavelle, MD
Related Links
- JAMA - Does This Adult Patient Have Septic Arthritis?
- Validation of a Clinical Prediction Rule for the Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children
- Factors Distinguishing Septic Arthritis from Transient Synovitis of the Hip in Children. A Prospective Study
- Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children with Clinical Prediction Algorithms
- Acute Pediatric Monoarticular Arthritis: Distinguishing Lyme Arthritis From Other Etiologies