O2090: Bedside Aspiration for Workup of the Pediatric Septic Hip: Avoid Trips to the OR and Expedited Time to Diagnosis

Background: Septic arthritis is a pediatric orthopaedic emergency that requires urgent diagnosis and management. An essential step in confirming diagnosis is joint synovial fluid aspiration, traditionally performed in the operating room (OR) or with the assistance of interventional radiology (IR). However, expeditious care via these pathways is frequently limited by IR personnel or OR availability. Therefore, our orthopaedic residents perform ultrasound-guided bedside arthrocentesis in the emergency department (ED). This study aimed to evaluate the impact of this practice on time to diagnosis and definitive treatment of septic arthritis of the hip. We hypothesized that bedside arthrocentesis/aspiration would decrease time to diagnosis, operative time, and number of patients taken to the OR who did not require formal debridement (I&D).

Methods: This is a retrospective study of patients who presented to our pediatric orthopaedic tertiary care emergency room and required a hip aspiration to rule out septic arthritis between 2003 and 2023. Patient demographics, Kocher criteria values, time to aspiration and final treatment are presented. Kruskal-Wallis and Fisher’s exact tests were used to compare demographic and clinical differences in RStudio using a two-sided level of significance of 0.05.

Results: Hip aspiration was performed to rule out septic arthritis in 57 patients (average age 5.1 years; 58% female). 28 patients underwent ED bedside aspiration, 11 patients underwent IR aspiration, 18 underwent hip aspiration in the OR with general anesthesia . Of the 28 patients who underwent bedside aspiration, 13 (46%) required definitive I&D in the OR. Of the 11 patients who underwent IR aspiration, 5 (45%) required definitive I&D in the OR. Of the 18 patients who underwent OR aspiration, 12 (67%) required a definitive I&D. Time to obtaining joint fluid was significantly shorter for patients undergoing bedside or IR guided aspiration compared to OR aspiration (7.4 hours vs. 5.3 hours vs. 15.7 hours, respectively). Time from presentation to OR for open surgical debridement, total operative time, and the percentage of patients requiring open surgical debridement did not significantly differ between groups.

Conclusion: Bedside hip aspiration by on-call orthopaedic residents provides an expedited method to diagnose septic hips in the ED and decreases the number of patients needing to be taken to the OR. Ultrasound-guided hip aspirations performed by orthopaedic residents is safe and teachable. It decreases the time to diagnosis and avoiding unnecessary trips to the operating room.