{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:48:47Z","timestamp":1780472927258,"version":"3.54.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>In Lyme disease endemic areas, Lyme and septic arthritis often present similarly. A published septic knee arthritis clinical prediction rule includes 2 high-risk predictors: absolute neutrophil count of 10,000 cells\/mm<jats:sup>3<\/jats:sup> or greater and erythrocyte sedimentation rate of 40 mm\/h or greater. The objective of the study was to externally validate this prediction rule in a multicenter prospective cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We enrolled a prospective cohort of children with knee monoarthritis undergoing evaluation for Lyme disease at 1 of 8 Pedi Lyme Net emergency departments located in endemic areas. We defined a case of septic arthritis with a positive synovial fluid culture or a synovial fluid white blood cell count of 50,000 or greater per high powered field with a positive blood culture and Lyme arthritis with a positive or equivocal C6 EIA, followed by a positive supplemental immunoblot. Other children were classified as having inflammatory arthritis. We report the performance of the septic arthritis clinical prediction rule in our study population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of the 543 eligible children, 13 had septic arthritis (2.4%), 234 Lyme arthritis (43.1%), and 296 inflammatory arthritis (54.5%). Of the 457 children (84.2%) with available laboratory predictors, all children with septic arthritis were classified as high risk (sensitivity, 100%; 95% confidence interval [CI], 77.2%\u2013100%; specificity, 68.1%; 95% CI, 63.6\u201373.3; negative predictive value, 278\/278 [100%]; 95% CI, 98.6%\u2013100%). Of the 303 low-risk children, 52 (17.2%) underwent diagnostic arthrocentesis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The septic knee arthritis clinical prediction rule accurately distinguished between septic and Lyme arthritis in an endemic area. Clinical application may reduce unnecessary invasive diagnostic procedures.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000002455","type":"journal-article","created":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T22:02:12Z","timestamp":1621029732000},"page":"e881-e885","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area"],"prefix":"10.1097","volume":"38","author":[{"given":"Duncan S.","family":"Grant","sequence":"first","affiliation":[{"name":"Brown University, Providence, RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree N.","family":"Neville","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, 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D.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Nemours\/A.I. duPont Hospital for Children, Wilmington, DE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupam B.","family":"Kharbanda","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd W.","family":"Lyons","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children's Hospital, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children's Hospital, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for Pedi Lyme 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