Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area
Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area
复制标题
DOI：
10.1097/pec.0000000000002455
复制
发表时间：
2022-02-01
影响因子：
1.4
通讯作者：
Nigrovic, Lise E.
中科院分区：
文献类型：
--
作者：
Grant, Duncan S.;Neville, Desiree N.;Nigrovic, Lise E.
目的在莱姆病流行区，莱姆病与脓毒性关节炎常表现相似。已发表的脓毒性膝关节炎临床预测规则包括2个高风险预测因子：中性粒细胞绝对计数≥ 10，000个细胞/mm（3）和红细胞沉降率≥ 40 mm/h。本研究的目的是在多中心前瞻性队列中对该预测规则进行外部验证。方法我们招募了一个前瞻性队列，在位于流行地区的8个Pedi Lyme Net急诊科之一接受莱姆病评估的膝关节单关节炎儿童。我们定义了一例脓毒性关节炎，滑液培养阳性或滑液白色血细胞计数≥ 50，000/高倍视野，血培养阳性，以及莱姆关节炎，C6 EIA阳性或可疑，随后补充免疫印迹阳性。其他儿童被归类为患有炎症性关节炎。我们报告了脓毒性关节炎临床预测规则在我们研究人群中的表现。结果543例患儿中化脓性关节炎13例（2.4%），莱姆关节炎234例（43.1%），炎性关节炎296例（54.5%）。在457名儿童中（84.2%）与可用的实验室预测，所有儿童脓毒性关节炎被列为高风险（敏感性，100%; 95%可信区间[CI]，77.2%-100%;特异性，68.1%; 95% CI，63.6-73.3;阴性预测值，278/278 [100%]; 95% CI，98.6%-100%）。在303名低风险儿童中，52名（17.2%）接受了诊断性关节穿刺术。结论脓毒性膝关节炎的临床预测规则可以准确地区分脓毒性膝关节炎和莱姆病关节炎。临床应用可以减少不必要的侵入性诊断程序。
Objective In Lyme disease endemic areas, Lyme and septic arthritis often present similarly. A published septic knee arthritis clinical prediction rule includes 2 high-risk predictors: absolute neutrophil count of 10,000 cells/mm(3) or greater and erythrocyte sedimentation rate of 40 mm/h or greater. The objective of the study was to externally validate this prediction rule in a multicenter prospective cohort. Methods We enrolled a prospective cohort of children with knee monoarthritis undergoing evaluation for Lyme disease at 1 of 8 Pedi Lyme Net emergency departments located in endemic areas. We defined a case of septic arthritis with a positive synovial fluid culture or a synovial fluid white blood cell count of 50,000 or greater per high powered field with a positive blood culture and Lyme arthritis with a positive or equivocal C6 EIA, followed by a positive supplemental immunoblot. Other children were classified as having inflammatory arthritis. We report the performance of the septic arthritis clinical prediction rule in our study population. Results Of the 543 eligible children, 13 had septic arthritis (2.4%), 234 Lyme arthritis (43.1%), and 296 inflammatory arthritis (54.5%). Of the 457 children (84.2%) with available laboratory predictors, all children with septic arthritis were classified as high risk (sensitivity, 100%; 95% confidence interval [CI], 77.2%-100%; specificity, 68.1%; 95% CI, 63.6-73.3; negative predictive value, 278/278 [100%]; 95% CI, 98.6%-100%). Of the 303 low-risk children, 52 (17.2%) underwent diagnostic arthrocentesis. Conclusions The septic knee arthritis clinical prediction rule accurately distinguished between septic and Lyme arthritis in an endemic area. Clinical application may reduce unnecessary invasive diagnostic procedures.