Emergency Medicine Physician Fails to Diagnose Septic Arthritis

This case involves a twelve-year-old boy who was taken by EHS to a tertiary care facility with severe knee pain. The patient’s mother stated that a week prior to presentation, the patient experienced symptoms of an upper respiratory tract infection associated with low-grade fever, but the symptoms had resolved quickly. According to the mother, the boy’s knee pain started three days before the presentation, and she had brought him to a family physician who determined that the pain was most likely due to growing pains. The patient was admitted to the hospital when he became increasingly ill after a 6-hour emergency room (ER) wait. The patient was worked up for a septic knee joint and confirmed to have septic arthritis. Due to the severity of the illness, however, the patient required intubation and a two-week hospital stay. The boy was discharged but suffered from long-term joint damage and residual kidney damage from the septic shock endured during his care.

Question(s) For Expert Witness

1. What is the typical treatment for septic arthritis and what types of consults are usually requested by the ER physicians when suspecting such a condition?

Expert Witness Response E-004536

Medical management of infective arthritis focuses on adequate and timely drainage of the infected synovial fluid, administration of appropriate antimicrobial therapy, and immobilization of the joint to control pain. In general, it is very important to obtain a consultation with an orthopedic surgeon or rheumatologist. If the initial treatment response is poor or the etiology of the synovitis remains unknown, consultations with an infectious disease specialist can prove to be very helpful as well.