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Orthopedics and Osteoporosis 2018
Page 27
Journal of Clinical & Experimental Orthopaedics
ISSN: 2471-8416
E u r o p e a n C o n f e r e n c e o n
Orthopedics and
Osteoporosis
N o v e m b e r 2 9 - 3 0 , 2 0 1 8
Am s t e r d a m , N e t h e r l a n d s
Introduction: One of the most common investigations in orthopaedics is
aspiration of the native hot swollen knee for septic arthritis: patients often
discharged if gram stain is negative. This is a serious condition: mortality
of 4-42% is seen. Literature demonstrates wide variation in positive sample
rates. We aimed to compare results of initial microscopy and inflammatory
markers with definitive culture and sensitivities (CS). We also assessed quality
of departmental handover documentation and process.
Methods: We identified all patients from Oct’ 2017-Jul’ 2018 from handover
lists at our orthopaedic unit presenting with hot swollen native knee joints.
We used clinical information systems to retrospectively collect data; audited
based on 2007 joint national UK guidelines.
Results: 1) Microbiology: total patients: 62, negative Gram stain (GS) and
negative CS: 55, negative GS and positive CS: 7, positive GS and positive CS:
0, positive GS and negative MCS: 0. Culture: Staphylococcus aureus 50%,
Strep G 16%, others: 16%. GS Sensitivity: 0, Specificity: 1, positive predictive
value (PPV): 0, negative predictive value (NPV): 0.98. Pus cells 3+: sensitivity
1, specificity 0.83, PPV 0.17, NPV 0.92. WCC>12: sensitivity 0.57, specificity
0.83, PPV 0.17, NPV 0.92. CRP>0: sensitivity 1, specificity 0.41, PPV 0.12, NPV
1.
Documentation audit: WCC documented: 88%, CRP documented: 90%, urate
documented: 24%, complete microscopy result documented: 59%, 48 hr date
for MCS documented: 0%, 5 day MCS date documented: 18%.
Process audit: WCC taken: 100%, CRP taken: 99%, urate taken: 64%, synovial
fluid taken before Abx: 97%, aspirate taken: 100%, MCS obtained: 100%.
Discussion: We showed low sensitivity of blood tests and GS results in
predicting positive septic arthritis, with some usefulness of pus cells. This
emphasises importance of clinical history and examination in informing
initial management decisions. A bigger investigation is warranted. To improve
handover process, we designed a new proforma.
Biography
Paul Andrzejowski completed his Bachelor of Medical Science
(Hons) in 2011 and Bachelor of Medicine and Surgery degree
in 2013 from the University of Nottingham, UK. He has recently
passed MRCS Membership exams to the Royal College of
Surgeons of Edinburgh. He has completed his core surgical
training programme in Yorkshire with a special interest in
Trauma and Orthopaedics, and is currently working as a
Research Fellow in Trauma and Orthopaedics at the Leeds
General Infirmary.
Native knee septic arthritis: sensitivity and specificity of
investigations
Paul Andrzejowski
Bradford Royal Infirmary, UK
Paul Andrzejowski, J Clin Exp Orthop 2018, Volume: 4
DOI: 10.4172/2471-8416-C1-005