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Kocher Criteria for Septic Arthritis

Distinguishes septic arthritis from transient synovitis in a child with an inflamed hip.

About the Creator
Mininder S. Kocher
Dr. Mininder S. Kocher
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    Advice

    • Obtain a thorough history and physical exam on all pediatric patients presenting with an acutely irritable hip, paying particular concern to presence or history of fever and inability to bear weight.
    • Draw a CBC, ESR and CRP in all patients with a clinical concern for septic arthritis or transient synovitis.

    Management

    • Consider diagnostic hip aspiration in patients with a clinical concern for septic arthritis that have at least one predictor for septic arthritis
    • If there is a high clinical suspicion do not delay orthopedic consultation.
    • Consider observation and/or discharge with close follow-up in well-appearing patients with a low clinical suspicion for septic arthritis and no predictors present.

    Critical Actions

    Patients meeting none or all of the Kocher criteria can potentially be discharged (0 predictors) or require urgent orthopedics consultation for washout (4 predictors). Those with some predictors may require hip arthrocentesis.

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