Lyons et al reported a clinical prediction rule for identifying a child with a musculoskeletal arthritis in a Lyme endemic region. This can help guide investigations. The authors are from multiple institutions in the United States.
Patient selection: pediatric patient with monoarthritis in a Lyme endemic region
Musculoskeletal infections include septic arthritis, osteomyelitis and pyomyositis.
Prevalence of musculoskeletal infection (MSKI) in study population: 6%
Parameters:
(1) serum procalcitonin
(2) serum CRP
(3) serum Lyme C6 by EIA
Procalcitonin
CRP
C6
Risk MSKI
>= 0.5 ng/mL
NA
NA
high (57%)
< 0.5 ng/mL
< 0.6 mg/dL
NA
very low
< 0.5 ng/mL
>= 0.6 mg/dL
positive or equivocal
very low
< 0.5 ng/mL
>= 0.6 mg/dL
negative
moderate (15%)
Performance:
• The sensitivity was 100% and specificity 74%.
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