POCUS and Fluid Aspiration by PEM Physicians Leads to Shorter Time to Diagnosis and Treatment of Septic Hip

Background: Without early recognition and prompt institution of appropriate medical and surgical therapy, septic has the potential to cause permanent disability. Diagnosis is made by identifying fluid in the hip joint and aspiration of the fluid. Traditionally ultrasound is performed in Radiology and fluid aspiration by Orthopedic surgeons. However, in recent years Pediatric emergency medicine physicians have become competent in hip US and some in ultrasound guided hip effusion aspiration as well. The goal of our study was to compare time to diagnosis, treatment and discharge between children with septic hip diagnosed by Orthopedic and PEM physicians.

Methods: We collected and analyzed clinical data of patients, discharged with a diagnosis of septic hip in the last 5 years from the electronic medical records of our medical center. Data was analyzed in 2 groups according to physician performing hip aspiration.

Results: A total of 32 cases were identified, 10 had us and fluid aspiration by PEM staff and 22 by Orthopedic surgeons. No significant differences were found between the groups regarding age, sex, laboratory values, temperature, effusion, time to admission and length of hospital stay. However, patients who received ER treatment, were diagnosed faster, mean of 5.2±4.0 hours in comparison to 17.6±14.7 hours (p=0.004, 95% CI -21.5 -4.1).

Conclusions: Our result demonstrate that ER treatment is feasible and allows shorter time to diagnosis and treatment