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Report by Nicola Wright; Search checked by Vince Choudhery
Clinical scenario
A 3 year old child presents to the emergency department with recent onset of left sided limp and no history of trauma. He is apyrexial, systemically well with a normal white cell count and erythrocyte sedimentation rate. You diagnose irritable hip and wonder whether x ray or ultrasonography is better at detecting a joint effusion.
Three part question
In [a child with an irritable hip] is [x ray better than ultrasonography] at [detecting a hip effusion]?
Search strategy
Medline 1966 to 10/99 using the OVID interface. [({exp hip joint OR exp hip OR hip$.mp} AND {exp pain OR pain$.mp OR irritable$.mp OR limp$.mp OR exp synovitis OR synovitis.mp}) AND {exp pediatric OR pediatric$.mp OR paediatric.mp OR child$] AND {exp ultrasonography OR ultrasound$.mp} LIMIT to human AND english.
Search outcome
Fifty two papers were found of which 46 were irrelevant or of insufficient quality for inclusion. The six remaining papers are shown in table 3.
Comment
In all the studies found, ultrasonography was its own gold standard for the detection of hip effusions. Therefore no comment about the sensitivity or specificity of ultrasonography itself can be made. Radiography is, however, clearly less sensitive than ultrasonography at detecting hip effusions. The role of x ray in detecting Perthes' disease should not be forgotten.
Clinical bottom line
Ultrasound is more sensitive than plain x ray at detecting hip effusions in children. It should be the first imaging investigation of the irritable hip.
Report by Nicola Wright; Search checked by Vince Choudhery