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- J. Sultan
- Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK.
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- P. J. Hughes
- Lancashire Teaching Hospitals, NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston PR2, 9HT, UK.
書誌事項
- タイトル別名
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- THE VALUE OF CLINICAL PREDICTION ALGORITHMS
説明
<jats:p> The crucial differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. In 1999, Kocher et al introduced four clinical predictors which were highly predictive (99.6%) of septic arthritis. These included fever (temperature ≥ 38.5°C), inability to bear weight, white blood-cell count > 12.0 × 10<jats:sup>9</jats:sup> cells/L and ESR ≥ 40 mm/hr; CRP ≥ 20 mg/L was later added as a fifth predictor. We retrospectively evaluated these predictors to differentiate septic arthritis from transient synovitis of the hip in children over a four-year period in a primary referral general hospital. When all five were positive, the predicted probability of septic arthritis in this study was only 59.9%, with fever being the best predictor. When applied to low-prevalence diseases, even highly specific tests yield a high number of false positives and the predictive value is thereby diminished. </jats:p><jats:p> Clinical predictors should be applied with caution when assessing a child with an irritable hip, and a high index of suspicion, and close observation of patients at risk should be maintained. </jats:p>
収録刊行物
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- The Journal of Bone and Joint Surgery. British volume
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The Journal of Bone and Joint Surgery. British volume 92-B (9), 1289-1293, 2010-09
British Editorial Society of Bone & Joint Surgery