Analysis of Patients Presenting to a Pediatric Emergency Department with Acute Limping

Abstract

Introduction: Limping is a common presenting complaint to a pediatric emergency department among children. The differential diagnosis of acute limp includes transient synovitis, trauma, infections, neoplasia, and congenital neuromuscular and developmental disorders. We aimed to evaluate patients presenting with acute limp to our pediatric emergency department and to analyze the clinical characteristics of the disease. In addition, we aimed to investigate the value of several laboratory parameters in early identification of septic and aseptic conditions. Methods: We retrospectively analyzed children under 18 years of age who were admitted to our emergency department with acute limping in a two-year period. Patients with any chronic diseases, any history of trauma, coagulopathy (as documented by blood clotting tests) and any history of intramuscular injections within the previous week were excluded. The patients’ complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, plain pelvic radiographs and ultrasonography reports were evaluated. The patients were classified as septic or aseptic according to their white blood cells (WBC), CRP and ESR values. Totally 120 patients were included in the study. The upper limit for WBC, ESR and CRP was accepted as 9000 cells/mm3, 20 mm/h and 0.8 mg/dL, respectively. Results: Of the total of 86 patients in the aseptic group, 81 had normal WBC, ESR and CRP levels and were diagnosed with transient synovitis, 2 female patients received the diagnosis of slipped upper femoral epiphysis, and 3 patients were diagnosed with Legg-Calvé-Perthes disease during clinical follow-up. The remaining 34 patients with high ESR, WBC and CRP levels were included in the septic group in whom the following diagnoses were established during the follow-up: septic arthritis (n=12), Familial Mediterranean Fever (n=4), juvenile rheumatoid arthritis (n=4), Guillain-Barré syndrome (n=3), osteomyelitis (n=3), acute rheumatic fever (n=3), spondyloarthritis (n=3) and Ewing sarcoma (n=2). There was a significant difference in CRP and WBC values between the septic and the aseptic groups, but no significant difference was found in ESR values. Conclusion: Acute atraumatic limp is a commonly encountered condition in children presenting to pediatric emergency departments. Transient synovitis is the most common cause of limping. CRP and WBC are two sensitive markers for diagnosing infectious and malignant etiology in this group of children.

Keywords

• fever
• fever management
• knowledge
• health professional
• children
• epilepsy
• convulsion
• seizure
• Child
• limping
• acute