{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T06:45:46Z","timestamp":1791787546424,"version":"4.3.4"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Objective:<\/jats:title>\n This study evaluates the clinical application of the modified Kocher criteria (MKC) in assessing septic arthritis of the hip (SAH) at a tertiary children\u2019s hospital.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A retrospective cohort study was conducted on subjects presenting to the emergency department and receiving a hip ultrasound over a 1-year period. Those without a hip effusion were excluded. Patient demographics, symptoms, imaging, labs, treatment, and final diagnoses were collected. SAH was defined clinically by the treating team, supported by patient presentation, lab\/imaging findings, operative intervention, and antibiotic therapy. Descriptive and bivariate statistics based on variable distribution were used during analysis.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A total of 326 subjects were identified, and 110 had effusion present on ultrasound. Eighteen (16.4%) underwent aspiration. Aspirated subjects had significantly higher cumulative MKC scores (\n P<\/jats:italic>\n =0.001) and higher median values for all individual MKC components, including CRP, WBC, ESR, maximum temperature, and a higher prevalence of non-weight-bearing (\n P<\/jats:italic>\n <0.05). SAH was diagnosed in 38.9% of the aspirated group (n=7), with MKC scores of 2 (n=2), 3 (n=3), and 5 (n=2). Aspiration rates increased across MKC scores 0 to 3, and synovial fluid inflammatory markers trended higher with increasing MKC scores. Thirteen subjects with an MKC score of 2 were not aspirated; final diagnoses included transient synovitis (n=9), hip effusion, osteomyelitis, sickle cell crisis, or limp (each n=1). Three subjects with an MKC score of 3 were not aspirated and later diagnosed with metastatic tumor, osteomyelitis, and rheumatic fever.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Pediatric patients undergoing hip aspiration with a concern for SAH had significantly higher cumulative MKC scores and higher levels of all individual MKC components than their nonaspirated counterparts. However, nearly 15% of patients had MKC scores of 2 or 3 that were not aspirated in the ED, and SAH was identified even in lower-score subjects. While MKC scores appear to influence clinical decision-making, diagnostic variability remains. In patients with intermediate MKC scores of 2 to 3, the criteria should prompt further evaluation, taking into consideration the overall clinical context to guide aspiration decision-making.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/pec.0000000000003734","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T06:00:15Z","timestamp":1791784815000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Variability in the Modified Kocher Criteria for Septic Arthritis of the Hip"],"prefix":"10.1097","author":[{"given":"Sean P.","family":"Owens","sequence":"first","affiliation":[{"name":"Division of Orthopedic Surgery, The Children\u2019s Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Ho","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sula","family":"Frausto","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Talwar","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, The Children\u2019s Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Goodbody","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, The Children\u2019s Hospital of Philadelphia"},{"name":"Perelman School of Medicine at the University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron E.","family":"Chen","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania"},{"name":"Division of Emergency Medicine, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8727-127X","authenticated-orcid":false,"given":"Naomi J.","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, The Children\u2019s Hospital of Philadelphia"},{"name":"Perelman School of Medicine at the University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"R1-20261012","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1177\/18632521221106383","article-title":"The modified Kocher criteria for septic hip: does it apply to the knee?","volume":"16","author":"Bisht","year":"2022","journal-title":"J Child Orthop"},{"key":"R2-20261012","first-page":"e66184","article-title":"Paediatric septic arthritis of the hip and the efficacy of Kocher\u2019s criteria: a literature 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era?","volume":"12","author":"Valisena","year":"2024","journal-title":"Microorganisms"},{"key":"R6-20261012","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1097\/01.bpb.0000228388.32184.7f","article-title":"The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children","volume":"15","author":"Zamzam","year":"2006","journal-title":"J Pediatr Orthop B"},{"key":"R7-20261012","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jor.2017.06.004","article-title":"Nationwide survey of pediatric septic arthritis in the United States","volume":"14","author":"Okubo","year":"2017","journal-title":"J Orthop"},{"issue":"1 suppl","key":"R8-20261012","doi-asserted-by":"crossref","first-page":"104064","DOI":"10.1016\/j.otsr.2024.104064","article-title":"Treatment of septic arthritis of the hip in children","volume":"111","author":"Mallet","year":"2025","journal-title":"Orthop Traumatol Surg Res"},{"key":"R9-20261012","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1007\/s43465-022-00616-5","article-title":"Treatment of septic arthritis of the hip joint using repeated aspirations: when should we operate?","volume":"56","author":"Rotem","year":"2022","journal-title":"Indian J Orthop"},{"key":"R10-20261012","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.ajem.2015.12.090","article-title":"Treatment of septic hip in a pediatric ED: a retrospective case series analysis","volume":"34","author":"Kotlarsky","year":"2016","journal-title":"Am J Emerg Med"},{"key":"R11-20261012","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1007\/s00264-023-05751-8","article-title":"Surgical treatment of septic arthritis of the hip in children: arthrotomy compared with repeated aspiration-lavage","volume":"47","author":"Cohen","year":"2023","journal-title":"Int Orthop"},{"key":"R12-20261012","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/BPB.0000000000000345","article-title":"Percutaneous aspiration and irrigation technique for the treatment of pediatric septic hip: effectiveness and predictive parameters","volume":"25","author":"Weigl","year":"2016","journal-title":"J Pediatr Orthop B"},{"key":"R13-20261012","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/PEC.0000000000002650","article-title":"Point-of-care ultrasound-guided aspiration of the hip joint by an emergency medicine physician: a pediatric retrospective case series","volume":"38","author":"Berant","year":"2022","journal-title":"Pediatr Emerg Care"},{"key":"R14-20261012","doi-asserted-by":"crossref","first-page":"1311862","DOI":"10.3389\/fped.2023.1311862","article-title":"Septic arthritis in the pediatric hip joint: a systematic review of diagnosis, management, and outcomes","volume":"11","author":"Nannini","year":"2023","journal-title":"Front Pediatr"},{"key":"R16-20261012","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.2106\/00004623-199912000-00002","article-title":"Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm","volume":"81","author":"Kocher","year":"1999","journal-title":"J Bone Joint Surg Am"},{"key":"R17-20261012","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.2106\/00004623-200408000-00005","article-title":"Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children","volume":"86","author":"Kocher","year":"2004","journal-title":"J Bone Joint Surg Am"},{"key":"R18-20261012","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.2106\/00004623-200606000-00012","article-title":"Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study","volume":"88","author":"Caird","year":"2006","journal-title":"J Bone Joint Surg Am"},{"key":"R19-20261012","first-page":"e2112","article-title":"Distinguishing pediatric Lyme arthritis of the hip from transient synovitis and acute bacterial septic arthritis: a systematic review and meta-analysis","volume":"10","author":"Cruz","year":"2018","journal-title":"Cureus"},{"key":"R20-20261012","doi-asserted-by":"crossref","first-page":"706","DOI":"10.55275\/JPOSNA-2023-706","article-title":"Differentiating between septic arthritis and Lyme arthritis in the pediatric population","volume":"5","author":"Ortiz","year":"2024","journal-title":"J Pediatr Soc North Am"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/PEC.0000000000003734","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T06:00:18Z","timestamp":1791784818000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/PEC.0000000000003734"}},"subtitle":["Implications for Aspiration Decision-Making"],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":19,"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003734","relation":{},"ISSN":["0749-5161","1535-1815"],"issn-type":[{"value":"0749-5161","type":"print"},{"value":"1535-1815","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"assertion":[{"value":"2026-05-08","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}