In this episode of PEM Chatt, Dr. Jordan Foutch discusses the approach to evaluating a limping child in the pediatric emergency department. He emphasizes the importance of considering septic arthritis as a possibility, especially when fever is present. Dr. Foutch outlines the initial workup, including physical examination techniques, lab tests like CBC, inflammatory markers, and imaging studies. He explains the Kocher criteria for risk stratification and discusses the management approach, including when to involve orthopedics and consider joint aspiration or MRI. The conversation also covers various mimickers of septic joint, such as transient synovitis, osteomyelitis, and non-orthopedic conditions. Dr. Foutch provides valuable insights on communicating with parents, making admission decisions, and key pearls for diagnosing and managing limping children in the emergency setting.

Link to Kocker Criteria:

https://www.mdcalc.com/calc/1817/kocher-criteria-septic-arthritis

Link to references:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10974044/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774603/

https://www.uptodate.com/contents/evaluation-of-limp-in-children?search=limp child&source=search_result&selectedTitle=1~113&usage_type=default&display_rank=1

https://www.uptodate.com/contents/bacterial-arthritis-clinical-features-and-diagnosis-in-infants-and-children?search=septic arthritis child&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1