The Kocher criteria are a tool useful in the differentiation of

septic arthritis Acute septic arthritis, infectious arthritis, suppurative arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, hea ...

from

transient synovitis Transient synovitis of hip (also called toxic synovitis; see below for more synonyms) is a self-limiting condition in which there is an inflammation of the inner lining (the synovium) of the capsule of the hip joint. The term irritable hip refe ...

in the child with a painful hip. They are named for Mininder S. Kocher, an

orthopaedic surgeon Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

Boston Children's Hospital Boston Children's Hospital formerly known as Children's Hospital Boston until 2012 is a nationally ranked, freestanding acute care children's hospital located in Boston, Massachusetts, adjacent both to its teaching affiliate, Harvard Medical Scho ...

and Professor of Orthopaedic Surgery at

Harvard Medical School Harvard Medical School (HMS) is the graduate medical school of Harvard University and is located in the Longwood Medical Area of Boston, Massachusetts. Founded in 1782, HMS is one of the oldest medical schools in the United States and is consi ...

. The original study used retrospective pediatric cases to develop the criteria over multiple years. The score is primarily used in orthopedic cases in which the symptoms experienced in septic arthritis and transient synovitis are similar. The criteria can be used on multiple joints — the hip being the most tested given its frequency of diagnosis and importance to the patient's mobility. The knee and the ankle can also experience these symptoms and the criteria can be applied to symptomatic joints such as these. Septic arthritis is an orthopedic emergency, which, if treatment is delayed, can lead to irreversible joint damage. Septic arthritis occurs more often in childhood than at any other time. Kocher Criteria are a useful guide to the diagnosis of septic arthritis in children, especially in the hip, one of the most frequently affected joints. However, the attending physician is requested to put this criteria into clinical context. For example, the attending physician has to use his own clinical judgement and experience to rule out the presence of concurrent acute hematogenous osteomyelitis in cases of proven

. Further, children with septic arthritis - of hip - are highly unlikely to be able to weight bear freely. Contrastingly, children with

of the hip can occasionally.

Scoring

A point is given for each of the four following criteria: * Non-weight-bearing on affected side *

Erythrocyte sedimentation rate The erythrocyte sedimentation rate (ESR or sed rate) is the rate at which red blood cells in anticoagulated whole blood descend in a standardized tube over a period of one hour. It is a common hematology test, and is a non-specific measure of ...

> 40 * Fever > 38.5 °C *

White blood cell count A complete blood count (CBC), also known as a full blood count (FBC), is a set of medical laboratory tests that provide information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and pl ...

> 12,000

References

Orthopedic clinical prediction rules {{Orthopedics-stub

Scoring

See also

References