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Erythrocyte sedimentation rate and septic arthritis in children
  1. Russell Boyd,
  2. Bruce Martin
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M139WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}

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Report by Russell Boyd, Consultant Search checked by Bruce Martin, Specialist Registrar

Clinical scenario

A 3 year old child presents to the emergency department with a short history of limp, temperature and difficulty in weight bearing on the left leg. The pain is principally located at the hip joint and you fear this may be a septic arthritis. You wonder if an erythrocyte sedimentation rate (ESR) will help in excluding the diagnosis of septic arthritis.

Three part question

In [children presenting with acute hip pain] is [a raised ESR] useful in [dignosing septic arthritis].

Search strategy

Medline 1966–12/00 using the OVID interface. {[(exp child OR OR pediatrics OR OR AND (exp hip OR exp hip joint OR OR exp arthritis, infectious OR exp osteomyelitis OR septic] AND (exp laboratory techniques and procedures OR laboratory OR exp ultrasonography OR exp blood cell count OR exp c-reactive protein)} AND maximally sensitive diagnostic filter LIMIT to human and english.

Search outcome

Altogether 334 papers found of which 329 were irrelevant or of insufficient quality. The remaining five papers are shown in table 6.

Table 6


An isolated ESR is of variable sensitivity and not suitable to rule out septic arthritis, however in combination with an increased temperature and inability to weight bear or reduced mobility it becomes a useful rule out tool with sensitivities consistently above 95%.

Clinical bottom line

An isolated ESR test cannot exclude septic arthritis. In combination with temperature and ability to weight bear it can be used as a SnOut.

Report by Russell Boyd, Consultant Search checked by Bruce Martin, Specialist Registrar


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