{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:09:25Z","timestamp":1793390965387,"version":"4.5.0"},"reference-count":33,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE:<\/jats:title>\n                  <jats:p>Because Lyme and septic arthritis may present similarly, we sought to identify children with knee monoarthritis at low risk for septic arthritis who may not require arthrocentesis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We performed a retrospective study of children with knee monoarthritis presenting to 1 of 2 pediatric centers, both located in Lyme disease\u2013endemic areas. Septic arthritis was defined by a positive result on synovial fluid culture or synovial fluid pleocytosis with a positive blood culture result. Lyme arthritis was defined as a positive Lyme serologic result or physician-documented erythema migrans rash. All other children were considered to have other inflammatory arthritis. A clinical prediction model was derived by using recursive partitioning to identify children at low risk for septic arthritis, and the model was then externally validated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>We identified 673 patients with knee monoarthritis; 19 (3%) had septic arthritis, 341 (51%) had Lyme arthritis, and 313 (46%) had other inflammatory arthritis. The following predictors of knee septic arthritis were identified: peripheral blood absolute neutrophil count \u226510 \u00d7 103 cells per mm3 and an erythrocyte sedimentation rate \u226540 mm\/hour. In the validation population, no child with a absolute neutrophil count &amp;lt;10 \u00d7 103 cells per mm3 and an erythrocyte sedimentation rate &amp;lt;40 mm\/hour had septic arthritis (sensitivity: 6 of 6 [100%], 95% confidence interval [CI]: 54\u2013100; specificity: 87 of 160 [54%], 95% CI: 46\u201362). Overall, none of the 19 children with septic arthritis were classified as low risk (10%, 95% CI: 0\u201317).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Laboratory criteria can be used to identify children with knee monoarthritis at low risk for septic arthritis who may not require diagnostic arthrocentesis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2012-2531","type":"journal-article","created":{"date-parts":[[2013,2,19]],"date-time":"2013-02-19T13:03:39Z","timestamp":1361279019000},"page":"e695-e701","source":"Crossref","is-referenced-by-count":75,"title":["Distinguishing Lyme From Septic Knee Monoarthritis in Lyme Disease\u2013Endemic Areas"],"prefix":"10.1542","volume":"131","author":[{"given":"Julia K.","family":"Deanehan","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir A.","family":"Kimia","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharman P.","family":"Tan Tanny","sequence":"additional","affiliation":[{"name":"Melbourne Medical School, Melbourne, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"Milewski","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut; and"},{"name":"Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul G.","family":"Talusan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian G.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,3,1]]},"reference":[{"key":"2021120900353780800_B1","first-page":"1","article-title":"Centers for Disease Control and Prevention (CDC). Surveillance for Lyme disease\u2014United States, 1992-2006.","author":"Bacon","journal-title":"MMWR Surveill Summ"},{"issue":"3","key":"2021120900353780800_B2","doi-asserted-by":"crossref","first-page":"252","DOI":"10.2106\/JBJS.I.01776","article-title":"Lyme arthritis in children presenting with joint effusions.","volume":"93","author":"Milewski","year":"2011","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"2021120900353780800_B3","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/S0022-3476(86)80688-6","article-title":"Childhood Lyme arthritis: experience in an endemic area.","volume":"109","author":"Eichenfield","year":"1986","journal-title":"J Pediatr"},{"issue":"4 pt 1","key":"2021120900353780800_B4","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1542\/peds.102.4.905","article-title":"Lyme arthritis in children: clinical epidemiology and long-term outcomes.","volume":"102","author":"Gerber","year":"1998","journal-title":"Pediatrics"},{"issue":"14","key":"2021120900353780800_B5","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1056\/NEJM199309303291407","article-title":"Acute monoarthritis.","volume":"329","author":"Baker","year":"1993","journal-title":"N Engl J Med"},{"issue":"5","key":"2021120900353780800_B6","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1002\/art.1780400516","article-title":"The outcome of bacterial arthritis: a prospective community-based study.","volume":"40","author":"Kaandorp","year":"1997","journal-title":"Arthritis Rheum"},{"issue":"10","key":"2021120900353780800_B7","first-page":"955","article-title":"Acute bacterial arthritis in the adult.","volume":"17","author":"Shulman","year":"1988","journal-title":"Orthop Rev"},{"issue":"5","key":"2021120900353780800_B8","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/00006565-199810000-00013","article-title":"Emergency department presentations of Lyme disease in children.","volume":"14","author":"Bachman","year":"1998","journal-title":"Pediatr Emerg Care"},{"issue":"5","key":"2021120900353780800_B9","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/01241398-198709000-00005","article-title":"Musculoskeletal manifestations of Lyme disease in children.","volume":"7","author":"Cristofaro","year":"1987","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"2021120900353780800_B10","doi-asserted-by":"crossref","first-page":"96","DOI":"10.2106\/00004623-198769010-00016","article-title":"Lyme arthritis in children. An orthopaedic perspective.","volume":"69","author":"Culp","year":"1987","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"2021120900353780800_B11","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/01241398-199403000-00020","article-title":"Pediatric Lyme arthritis: clinical spectrum and outcome.","volume":"14","author":"Rose","year":"1994","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"2021120900353780800_B12","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/01241398-200301000-00023","article-title":"Lyme arthritis presenting as acute septic arthritis in children.","volume":"23","author":"Willis","year":"2003","journal-title":"J Pediatr Orthop"},{"issue":"3","key":"2021120900353780800_B13","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1542\/peds.2008-1511","article-title":"Acute pediatric monoarticular arthritis: distinguishing Lyme arthritis from other etiologies.","volume":"123","author":"Thompson","year":"2009","journal-title":"Pediatrics"},{"issue":"8","key":"2021120900353780800_B14","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1086\/374395","article-title":"Serodiagnosis of Lyme disease by kinetic enzyme-linked immunosorbent assay using recombinant VlsE1 or peptide antigens of Borrelia burgdorferi compared with 2-tiered testing using whole-cell lysates.","volume":"187","author":"Bacon","year":"2003","journal-title":"J Infect Dis"},{"issue":"12","key":"2021120900353780800_B15","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"},{"issue":"8","key":"2021120900353780800_B16","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-A","author":"Kocher","year":"2004","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"2021120900353780800_B17","doi-asserted-by":"crossref","first-page":"956","DOI":"10.2106\/00004623-200405000-00011","article-title":"Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithms.","volume":"86-A","author":"Luhmann","year":"2004","journal-title":"J Bone Joint Surg Am"},{"issue":"9","key":"2021120900353780800_B18","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1302\/0301-620X.92B9.24286","article-title":"Septic arthritis or transient synovitis of the hip in children: the value of clinical prediction algorithms.","volume":"92","author":"Sultan","year":"2010","journal-title":"J Bone Joint Surg Br"},{"issue":"2","key":"2021120900353780800_B19","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/BPO.0b013e3181cfcd4f","article-title":"Comparison of bacteriologically proven septic arthritis of the hip and knee in children, a preliminary study.","volume":"30","author":"Joshy","year":"2010","journal-title":"J Pediatr Orthop"},{"key":"2021120900353780800_B20","volume-title":"Mastering Regular Expressions","author":"Friedl","year":"2006","edition":"3rd ed."},{"key":"2021120900353780800_B21","volume-title":"Regular Expressions Cookbook","author":"Goyvaerts","year":"2012","edition":"2nd ed."},{"issue":"2","key":"2021120900353780800_B22","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support.","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"issue":"23","key":"2021120900353780800_B23","first-page":"573","article-title":"Lyme disease\u2014United States, 2003-2005.","volume":"56","author":"Centers for Disease Control and Prevention (CDC)","year":"2007","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"4","key":"2021120900353780800_B24","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1056\/NEJM199401273300401","article-title":"Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis.","volume":"330","author":"Nocton","year":"1994","journal-title":"N Engl J Med"},{"issue":"1","key":"2021120900353780800_B25","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data.","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"issue":"9","key":"2021120900353780800_B26","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1111\/j.1553-2712.2008.00206.x","article-title":"Interobserver agreement in assessment of clinical variables in children with blunt head trauma.","volume":"15","author":"Gorelick","year":"2008","journal-title":"Acad Emerg Med"},{"issue":"1","key":"2021120900353780800_B27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7326\/0003-4819-93-1-1","article-title":"Antibiotic therapy in Lyme disease.","volume":"93","author":"Steere","year":"1980","journal-title":"Ann Intern Med"},{"issue":"5","key":"2021120900353780800_B28","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1177\/000992280504400506","article-title":"Lyme arthritis in 20 children residing in a non-endemic area.","volume":"44","author":"Saulsbury","year":"2005","journal-title":"Clin Pediatr (Phila)"},{"issue":"5","key":"2021120900353780800_B29","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1007\/s11908-004-0037-y","article-title":"Bacterial and Lyme arthritis.","volume":"6","author":"Ross","year":"2004","journal-title":"Curr Infect Dis Rep"},{"issue":"4","key":"2021120900353780800_B30","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1016\/j.idc.2005.07.007","article-title":"Lyme arthritis.","volume":"19","author":"Hu","year":"2005","journal-title":"Infect Dis Clin North Am"},{"issue":"13","key":"2021120900353780800_B31","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1001\/jama.297.13.1478","article-title":"Does this adult patient have septic arthritis?","volume":"297","author":"Margaretten","year":"2007","journal-title":"JAMA"},{"issue":"3","key":"2021120900353780800_B32","doi-asserted-by":"crossref","first-page":"201","DOI":"10.7326\/0003-4819-144-3-200602070-00009","article-title":"Translating clinical research into clinical practice: impact of using prediction rules to make decisions.","volume":"144","author":"Reilly","year":"2006","journal-title":"Ann Intern Med"},{"issue":"3","key":"2021120900353780800_B33","doi-asserted-by":"crossref","first-page":"e666","DOI":"10.1542\/peds.2011-0043","article-title":"Clinical prediction rules for children: a systematic review.","volume":"128","author":"Maguire","year":"2011","journal-title":"Pediatrics"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/3\/e695\/1090478\/peds_2012-2531.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/3\/e695\/1090478\/peds_2012-2531.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T06:40:04Z","timestamp":1639032004000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/131\/3\/e695\/31005\/Distinguishing-Lyme-From-Septic-Knee-Monoarthritis"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,3,1]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2013,3,1]]},"published-print":{"date-parts":[[2013,3,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2012-2531","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,3,1]]}}}