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Citation:
Yap J, Kocher criteria for pediatric septic arthritis of the hip. Reference article, Radiopaedia.org (Accessed on 16 Mar 2025) https://doi.org/10.53347/rID-165585
The Kocher criteria for pediatric septic arthritis of the hip is a risk stratification score to aid in differentiating between septic arthritis and transient synovitis of the hip in the pediatric population.
1 point is applied to each of the above criteria. Based on the total number of points, the probability of septic arthritis is as follows 1:
0 points: <0.2%
1 point: 3%
2 points: 40%
3 points: 93%
4 points: 97%
if 1-2 criteria are present (intermediate probability), an orthopedic/radiology review is warranted for consideration of hip aspiration, which may require sedation
if 3-4 criteria are present (high probability), the patient will often proceed straight to arthroscopic surgical drainage under orthopedics
48% of patients with 3-4 criteria present (high probability) have been found to have underlying osteomyelitis 4
the Kocher criteria has limited utility in predicting septic arthritis of the knee 5
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1. Kocher M, Zurakowski D, Kasser J. Differentiating Between Septic Arthritis and Transient Synovitis of the Hip in Children: An Evidence-Based Clinical Prediction Algorithm. J Bone Joint Surg Am. 1999;81(12):1662-70. doi:10.2106/00004623-199912000-00002 - Pubmed
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2. Kocher M, Mandiga R, Zurakowski D, Barnewolt C, Kasser J. Validation of a Clinical Prediction Rule for the Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children. J Bone Joint Surg Am. 2004;86(8):1629-35. doi:10.2106/00004623-200408000-00005 - Pubmed
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3. Luhmann S, Jones A, Schootman M, Gordon J, Schoenecker P, Luhmann J. Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children with Clinical Prediction Algorithms. The Journal of Bone & Joint Surgery. 2004;86(5):956-62. doi:10.2106/00004623-200405000-00011 - Pubmed
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4. Nguyen A, Kan J, Bisset G, Rosenfeld S. Kocher Criteria Revisited in the Era of MRI: How Often Does the Kocher Criteria Identify Underlying Osteomyelitis? J Pediatr Orthop. 2017;37(2):e114-9. doi:10.1097/BPO.0000000000000602 - Pubmed
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5. Bisht R, Burns J, Smith C, Kang P, Shrader M, Belthur M. The Modified Kocher Criteria for Septic Hip: Does It Apply to the Knee? J Child Orthop. 2022;16(3):233-7. doi:10.1177/18632521221106383 - Pubmed
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