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A guideline for differential diagnosis between septic arthritis and transient synovitis in the ED: A Delphi survey

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Lee, Jin Hee; Park, Moon Seok; Kwon, Hyuksool; Chung, Chin Youb; Lee, Kyoung Min; Kim, Yu Jin; Kim, Kyuseok

Issue Date
W. B. Saunders Co., Ltd.
American Journal of Emergency Medicine, Vol.34 No.8, pp.1631-1636
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. (C) 2016 Elsevier Inc. All rights reserved.
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  • College of Medicine
  • Department of Medicine
Research Area Cerebral palsy, Medical image, Motion analysis, Pediatric orthopedic surgery, Statistics in orthopedic research


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