The Kocher criteria are a tool useful in the differentiation of

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

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 ref ...

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

orthopaedic surgeon Orthopedic surgery or orthopedics ( alternative spelling 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 2013) is the main pediatric training and research hospital of Harvard Medical School, Harvard University. It is a nationally ranked, freestanding acute care children ...

and Professor of Orthopaedic Surgery at

Harvard Medical School Harvard Medical School (HMS) is the medical school of Harvard University and is located in the Longwood Medical and Academic Area, Longwood Medical Area in Boston, Massachusetts. Founded in 1782, HMS is the third oldest medical school in the Un ...

. 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 these 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 in ...

> 40 * Fever > 38.5 °C *

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

> 12,000

References

Orthopedic clinical prediction rules {{Orthopedics-stub