Urgent Care Clinician | December 2023
An 8-year-old girl is brought to urgent care by her parents with a complaint of pain and swelling in her right knee. The parents report that the symptoms started 5 days ago and have gotten worse. They are concerned because she is unable to bear weight on that leg. There is no known history of recent trauma. The patient’s temperature is 38.6°C. On examination, her right knee is swollen, warm, and erythematous. The joint is exquisitely tender. Your urgent care clinic does not have the supplies to perform arthrocentesis. Which of the following is the best next step in the evaluation of this patient?
a. Order x-rays and serum blood tests.
b. Refer the patient to the ED.
c. Refer the patient to an orthopedic surgeon.
d. Assume this is septic arthritis and initiate antibiotic therapy, then send her home.
Click to see the answer
Answer: B. Any febrile child who presents with acute joint erythema, warmth, swelling, and intense pain with micromotion should be considered to have septic arthritis until proven otherwise. The standard of care is to send the patient to the ED for further evaluation, including arthrocentesis, empiric antibiotics, and orthopedic consultation. There is no reason to delay an arÂthrocentesis on a suspected septic arthritis patient while waiting for serum blood tests. In cases where the time to ED evaluation may be several hours and the patient is exhibiting signs of sepsis or severe infection, it may be prudent to provide an initial dose of parenteral antibiotics, if possible, but the patient should not be sent home.
For an in-depth review of this topic, access the full course.
