Patel et al reported a decision rule for identifying a pediatric patient with a musculoskeletal infection. The authors are from Children's Mercy Hospital in Kansas City.
Patient selection: 1 month to 17 years of age
Musculoskeletal infection: any combination of septic arthritis, osteomyelitis or pyomyositis
Parameters:
(1) body temperature in °C
(2) refusal to bear weight or pseudoparalysis
(3) C-reactive protein (CRP) in mg/dL
(4) white blood cell count in 10^9/L
(5) erythrocyte sedimentation rate (ESR) in mm per hour
Parameters
Findings
Points
body temperature
<= 38.3°C
0
> 38.3°C
1
symptoms
refusal to bear weight
1
pseudoparalysis
1
neither
0
CRP
<= 2.0 mg/dL
0
> 2.0 mg/dL
1
WBC count
<= 12 * 10^9/L
0
> 12 * 10^9/L
1
ESR
<= 40 mm/h
0
> 40 mm/h
1
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the greater the risk of a musculoskeletal infection.
Score
Probability of Infection
0
2%
1
5%
2
13%
3
29%
4
52%
5
75%
Performance:
• The area under the ROC curve is 0.82.
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