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AAOS: C-Reactive Protein Promoted for Diagnosis of Septic Arthritis in Children By Peggy Peck Special to DG News DALLAS, TX -- February 15, 2002 -- Serum C-reactive protein has a better discriminating capability than erythrocyte sedimentation rate, according to a study presented here yesterday at the 69th Annual Meeting of the American Academy of Orthopedic Surgeons. Currently, there is no gold standard test for diagnosing septic arthritis in children, according to Dr. Matthew J. Levine of Children’s Hospital, Philadelphia, Pennsylvania. Dr. Levine and colleagues studied a consecutive series of 133 children who had synovial fluid culture, gram stain and C-reactive protein (CRP) within 24 hours of presentation for suspected septic arthritis. The children were treated between January 1997 and January 2000. Septic arthritis was defined as either positive synovial fluid culture or a synovial fluid white blood cell count of greater than 50,000 with greater than 75 percent polymorphic neutrophils and a negative Lyme titer. Thirty-three of the patients were positive for septic arthritis, 94 were negative, which included 22 who had positive Lyme titers. Synovial fluid cultures were positive in 44 percent of the 33 patients with septic arthritis, Dr. Levine said. Dr. Levine said CRP had 41 to 90 percent sensitivity and 29 to 85 percent specificity. Positive predictive value was 34 to 53 percent, and negative predictive value was 78 to 87 percent. He said that ESR had similar results except, "the negative predictive value ranges from 76 percent to 85 percent. So while the value of both ESR and CRP is in the negative predictive value, CRP has a better discriminating ability." If the CRP is less than 1.0 mg/dL "the probability that the patient does not have septic arthritis is 87 percent", he noted, and CRP is faster than erythrocyte sedimentation rate (ESR). "The levels of CRP within six to eight hours peaks at 24 to 48 hours and declines faster than ESR," he said, "and the test results are back within an hour." "Clinical judgment is still critical but if you are only going to order one test it should be CRP," Dr. Levine concluded. In an interview, he said that either ESR or CRP should only be used as "part of the overall clinical assessment. If you aren’t sure whether or not to take the patient to the [operating room] and the CRP comes back at less than 1 [mg/dL], you can be more comfortable with watchful waiting." E-mail this page to a friend or colleague! To print, use this version