Evaluation of causes of acute hip pain in children at Erbil teaching hospital


Objectives: Painful hip in children is a common pediatric problem and there are several causes for hip pain. In this study we will show the most common causes of hip pain in children and evaluate the procedures performed at our hospital, with a view of establishing which parameters most relevant to make a clinical decision. Methods: This is a case review study which was carried out at Erbil Teaching Hospital between December 2006 and October 2007. Sixty two patients who had con¬sultations and/or been admitted at our hospital complaining of hip pain were included in this study. We did investigations for them and we reviewed their clinical, laboratory and imaging documents.Results: The differential diagnosis was transient synovitis (TS) 54.8%, Legg-Calves-Perthes disease 24.2%, septic arthritis (SA) 8.1%, traumatic synovitis 4.8%, avulsion fractures 3.2 %, brucellosis 1.6%, tuberculosis 1.6%, and non specific synovitis 1.6%. We found that three or more criteria,(the clinical and laboratory parameters), were present in all cases of septic arthritis (100% sensitivity), but also were present in 10% of non septic conditions (90% specificity). Radiographs showed abnormalities in 50% of the cases. Ultrasound showed joint effusion in 43 patients with 100% of sensitivity. Conclusions: Transient synovitis is the most common cause of irritable hip. Application of our scheme might result in a reduction of the number of patients who need hospital admission and also reduction of invasive procedures and containment of the cost. Keywords: Diagnosis of painful hip.