Extract
To The Editor:I read with interest the article "Differentiation Between Septic
Arthritis and Transient Synovitis of the Hip in Children with Clinical
Prediction Algorithms" (2004;86:956-62), by Luhmann et al., in which the
distribution of a variety of demographic, clinical, and laboratory parameters
in children with septic arthritis or transient synovitis of the hip was
compared. The authors found that the two populations differed in terms of
history of fever, erythrocyte sedimentation rate values, white blood-cell
count in the synovial fluid, and cellular composition of the peripheral blood
and joint fluid leukocytes. Of the forty-seven children included in the group
with composite septic arthritis, twenty had either a positive synovial fluid
culture or a positive blood culture and a synovial fluid white blood-cell
count of =50 × 109/L ("true septic arthritis") and
twenty-seven had negative blood or synovial fluid cultures and a synovial
fluid white blood-cell count of =50 × 109/L ("presumed septic
arthritis"). Although no explicit criteria for defining a positive
bacteriological culture were stated in the Materials and Methods section of
the article, examination of the list of organisms isolated from patients in
the group with true septic arthritis raises some concerns.