C-reactive protein (CRP) level is used at our tertiary paediatric hospital in the diagnosis, management, and discharge evaluation of paediatric septic arthritis patients. The purpose of this study was to evaluate the efficacy of a discharge criterion of CRP less than 2 mg/dL for patients with septic arthritis in preventing reoperation and readmission. We also aimed to identify other risk factors of treatment failure.

Patients diagnosed with septic arthritis between January 1, 2007 and December 31, 2017 were reviewed retrospectively. The diagnosis of septic arthritis was made based on clinical presentation, laboratory results and the finding of purulent material on joint aspiration or the isolation of a bacterial pathogen from joint fluid or tissue. Bivariate tests of associations between patient or infection factors and readmission and reoperation were performed. Quantitative variables were analyzed using Mann-Whitney tests and categorical variables were analyzed using Chi-square tests.

One hundred eighty-three children were included in the study. Seven (3.8%) were readmitted after hospital discharge for further management, including additional advanced imaging, and IV antibiotics. Six (85.7%) of the readmitted patients underwent reoperation. Mean CRP values on presentation were similar between the two groups: 8.26 mg/dL (± 7.87) in the single-admission group and 7.94 mg/dL (± 11.26) in the readmission group (p = 0.430). Mean CRP on discharge for single-admission patients was 1.71 mg/dL (± 1.07), while it was 1.96 mg/dL (± 1.19) for the readmission group (p = 0.664), with a range of < 0 .8 to 6.5 mg/dL and a median of 1.5 mg/dL for the two groups combined. A total of 48 children (25.9%) had CRP values greater than the recommended 2 mg/dL at discharge, though only three of these patients (6.2%) were later readmitted. The only common variable in the readmitted children was either a negative culture result at time of discharge or atypical causative bacteria.

CRP values are useful in monitoring treatment efficacy but not as reliable as a discharge criterion to prevent readmission or reoperation in children with septic arthritis. We recommend determining discharge readiness on the basis of clinical improvement and downtrending CRP values. There was a higher risk of readmission in children with an atypical causative bacteria and when culture results were negative at discharge. Close monitoring of these patients after discharge is suggested to identify signs of persistent infection.

The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) is a validated patient reported outcome tool for paediatric foot and ankle conditions. It includes three domains with a maximum score of 100: physical, school and play, and emotional. The purpose of this cross-sectional study is to examine the differences between self-reported child and parent responses of different age groups, genders, and child-parent combinations.

During a ten-month period, paediatric patients aged eight to 16 years and their parents completed the OxAFQ-C during routine clinic visits, providing a total 116 child-parent questionnaire dyads. Demographics and diagnostic information was obtained through medical record review. Parent and child responses in each domain were compared for concordance and for effect of demographic variables on the results. Means and standard deviations for parent and child questionnaires for each domain were reported and compared using a two-sample Wilcoxon rank-sum test. A multivariate regression model was used to assess the correlation between demographic characteristics with domain scores. Absolute agreement between patient and parent questionnaires was assessed using intra-class correlation coefficients (ICC) with a two-way random effects model.

Seventy patients (60.3%) were female and 46 (39.7%) were male, the majority of parent respondents were mothers (85.3%), followed by fathers (11.2%). Mean patient age was 12.4 (± 2.2) years. Higher scores were reported by the child in every domain, though only the emotional domain score showed statistical significance (p = 0.024) between the parent scores. Male children scored significantly higher than females in school and play domain, (mean 82.38 vs 71.13, p = 0.037) and in the emotional domain (means 90.89 vs79.10, p = 0.002). Parents of males scored significantly higher than parents of females only in the emotional domain (means 86.95 vs 72.67, p = 0.001). Children younger than 13 years old scored significantly higher than older children in the emotional domain (p = 0.004).

Child and parent responses for the OxAFQ-C are statistically concordant in the physical and school and play domains. Though children consistently scored themselves higher than their parents did in all domains, only differences in responses for the emotional domain were significant. The level of agreement between parent and child increases with in patients over 13 years of age. Both females and parents of females report lower scores than males and their male parents. Though the use of OxAFQ-C is supported and confirms parent perception of their child's foot and ankle condition is accurate, further research is needed to better understand gender and age differences on response concordance.

The best algorithm, measurements, and criteria for screening children with Down syndrome for upper cervical instability are controversial. Many authors have recommended obtaining flexion and extension views. We noted that patients who require surgical stabilization due to myelopathy or cord compression typically have grossly abnormal radiographic measurements on the neutral upright lateral cervical spine radiograph (NUL). This study was designed to determine whether a full series of cervical spine images including flexion/extension lateral radiographs (FEL) was important to avoid missing upper cervical instability.

This is a retrospective evaluation of cervical spine images obtained between 2006 and 2012 for the purposes of “screening” children with Down syndrome for evidence of instability. The atlanto-dental interval, space available for cord, and basion axial interval were measured on all films. The Weisel-Rothman measurement was made in the FEL series. Clinical outcome of those with abnormal measurements were reviewed. Sensitivity, specificity, positive and negative predictive values of NUL and FEL x-rays for identifying clinically significant cervical spine instability were calculated.

Two-hundred and forty cervical spine series in 213 patients with Down syndrome between the ages of four months and 25 years were reviewed. One hundred and seventy-two children had a NUL view, and 88 of these patients also had FEL views. Only one of 88 patients was found to have an abnormal ADI (≥6mm), SAC (≤14mm), or BAI (>12mm) on an FEL series that did not have an abnormal measurement on the NUL. This patient had no evidence of cord compression or myelopathy.

Obtaining a single NUL x-ray is an efficient method for radiographic screening of cervical spine instability. Further evaluation may be required if abnormal measurements are identified on the NUL x-ray. We also propose new “normal” values for the common radiographic measurements used in assessing risk of cervical spine instability in patients with Down syndrome.