Current Variation in Joint Aspiration Practice for the Evaluation of Pediatric Septic Arthritis

Pediatric septic arthritis (SA) is a condition that can be associated with significant morbidity. Although previous research has been on predictive care pathways, scrutiny of the literature continues to reveal wide differences in the patient evaluation and management. The purpose of this study was to define the differences in joint aspiration for the evaluation of pediatric SA across pediatric tertiary care institutions in the United States. METHODS: Surgeons from 18 pediatric tertiary care centers across the United States were surveyed on current institutional practices regarding joint aspiration, laboratory studies, MRI usage, and treatment timing in the evaluation for SA. Responses were recorded by institution and analyzed to generate descriptive statistics. RESULTS: Responses were received from all institutions asked to participate. Overall, joint specific practice variation exists regarding the person completing the aspiration, where the aspiration is performed, utilization of image guidance, and the utilization of anesthesia. Additional areas of variation included the method and calculation of cell count and the routine use of MRI. DISCUSSION: Significant practice variations exist across pediatric tertiary care centers for the evaluation of pediatric SA. Using these data, future prospective studies can be used to unify institutional practices to minimize practice variation and ultimately improve the care delivery to pediatric patients presenting with SA.