Outcomes of paediatric septic arthritis patients: rates of re-admission, re-operation, and unplanned emergency room visits after discharge.

PURPOSE: This study is aimed at determining the rates and predictors of re-operation and re-admission in children with septic arthritis treated at an institution without routine clinical practice guidelines.

METHODS: This is a retrospective cohort study of patients less than 18 years old who underwent surgery for septic arthritis between January 1, 2009, and January 1, 2019, at a single tertiary-care paediatric institution. Uni- and multivariate analysis was performed to identify any risk factors associated with re-operation or unplanned visits to the emergency department after hospital admission compared to patients who had an uncomplicated post-operative course.

RESULTS: One hundred and forty-four patients were included. The mean age was five years (range 1 month-17 years), and the most commonly affected joint was the hip. The re-admission rate was 1% (n = 2), and the re-operation rate was 8% (n = 12). Twenty percent of patients (n = 29) had unplanned presentations to the emergency department (ED) after discharge. Discharge CRP level was not significantly higher in patients with unplanned presentations to the ED or re-operation. Positive joint fluid culture and infection of any other joint than the hip increased the likelihood of re-operation. Patients who had septic arthritis of the hip were more likely to have an unplanned ED presentation.

CONCLUSIONS: Rates of re-admission and re-operation were similar to literature despite lack of a standardized treatment pathway or discharge protocol. Outcomes of pediatric septic arthritis did not correlate with discharge CRP level. There was a high rate of unplanned ED visits after discharge.