117 - Epidemiology and Success Rates of Joint Aspirations in Children with Suspected Septic Arthritis of the Hip 2016-2022 – Opportunities for Improvement?

Poster Number: 117
Publication Number: 117.1299

Background: There is significant variation in clinical practice in the approach to children with suspected septic arthritis of the hip, and little epidemiologic data on success rates of joint aspirations of the hip. In some institutions, hip aspirations are performed in the operating room, while in other institutions hip aspirations are performed by various providers that include general radiologists, interventional radiologists, orthopedic surgeons, or pediatric emergency medicine providers. There is also variability in adjunctive techniques, including landmark approaches and static or dynamic ultrasound guidance.

At our institution, an initial hip ultrasound is used to diagnose the presence of an effusion and a second order is placed to denote ultrasound guidance for a hip aspiration attempt. Historically, a radiology physician or technician was present to provide dynamic guidance to the orthopedic resident performing the procedure. To evaluate practice changes and improvements, we performed a chart review to obtain baseline data as a comparison.

Objective: Determine the epidemiology and characteristics of patients presenting with concern for septic arthritis seen at our institution.

Determine baseline success rate of hip arthrocentesis in the emergency department (ED) in anticipation of a procedure practice change.

Design/Methods: This is a retrospective manual chart review of children 0-18 years of age presenting to a pediatric ED between 2016 and 2022 with a concern for septic arthritis of the hip. All charts of children who had two hip ultrasound orders during one visit during the study time frame were reviewed to confirm documentation of a hip aspiration attempt as well as to collect demographic and clinical data.

Results: 57 patients met inclusion criteria for suspected hip septic arthritis with a joint aspiration attempt. Of this patient population, 44% had fever. 91% of the patients were limping or unable to bear weight and 9% could bear weight without gait changes. Bedside arthrocentesis was successful 95% of the time (54/57), defined as success in obtaining fluid. Further demographic and arthrocentesis data are available in table 1.

Conclusion(s): Hip aspiration success rates were high with our previous practice model. There are opportunities for improvement to the quality of arthrocentesis given a large number of “bloody taps” which can sometimes make interpretation of results challenging. We will use this data as baseline metrics for a quality improvement project aiming to monitor outcomes for arthrocentesis as we implement practice changes.