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Patankar AG, Coene RP, Cook DL, Feldman L, Hannon M, Yen YM, Milewski MD. Seasonal Variation of Pediatric Septic Arthritis in the United States: A PHIS Database Study. J Pediatr Orthop 2023; 43:e266-e270. [PMID: 36574359 DOI: 10.1097/bpo.0000000000002337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The presence of seasonal patterns in pediatric septic arthritis cases is a common orthopaedic teaching. Seasonal variation has been seen in centers outside of the United States and with other inflammatory and infectious joint-related conditions within the country, but it is unknown if a seasonal pattern exists among different regions of the United States. The purpose of this study was to examine the seasonal variation of septic arthritis within specific regions across the United States. METHODS The Pediatric Health Information System database was queried for all patients 19 years or younger who were treated for septic arthritis. Data from 34 pediatric hospitals in the Pediatric Health Information System initiative were included. Centers were organized by geographical region, and season of presentation was determined using equinoxes/solstices. χ 2 tests were performed to detect seasonal differences in septic arthritis for the entire cohort and separated by geographical region. Proportion differences along with 95% CIs were provided. RESULTS Between 2016 and 2019, there were 5764 cases of septic arthritis. Median age at diagnosis was 6.2 years (range: 0 to 19.0 y). Each season contributed 24% to 25% of the total septic arthritis cases, and there were no significant differences detected between the 4 seasons ( P =0.66). There was no seasonal variation seen in the Midwest, South, or West ( P =0.71, 0.98, 0.36, respectively). However, there was seasonal variation in the Northeast ( P =0.05), with fall and summer having a higher percentage of cases (28%) than the winter (21%). CONCLUSIONS This study showed no clear seasonal variation in septic arthritis in children across the United States using a national database of pediatric hospital centers. However, there is regional seasonal variation in the Northeast, which may relate to climate differences. With no clear seasonal variation across the United States, continued diligence is needed in diagnosing septic arthritis throughout the year. LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
| | - Ryan P Coene
- Department of Orthopedic Surgery, Division of Sports Medicine
| | - Danielle L Cook
- Department of Orthopedic Surgery, Division of Sports Medicine
| | - Lanna Feldman
- Department of Orthopedic Surgery, Division of Sports Medicine
| | - Megan Hannon
- Orthopedic Center and Emergency Medicine, Boston Children's Hospital.,Harvard Medical School, Boston, MA
| | - Yi-Meng Yen
- Department of Orthopedic Surgery, Division of Sports Medicine.,Harvard Medical School, Boston, MA
| | - Matthew D Milewski
- Department of Orthopedic Surgery, Division of Sports Medicine.,Harvard Medical School, Boston, MA
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Vickers ML, Pelecanos A, Tran M, Eriksson L, Assoum M, Harris PN, Jaiprakash A, Parkinson B, Dulhunty J, Crawford RW. Association between higher ambient temperature and orthopaedic infection rates: a systematic review and meta-analysis. ANZ J Surg 2019; 89:1028-1034. [PMID: 30974508 DOI: 10.1111/ans.15089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/29/2018] [Accepted: 01/05/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Many infectious diseases display seasonal variation corresponding with particular conditions. In orthopaedics a growing body of evidence has identified surges in post-operative infection rates during higher temperature periods. The aim of this research was to collate and synthesize the current literature on this topic. METHODS A systematic review and meta-analysis was performed using five databases (PubMed, Embase, CINAHL, Web of Science and Central (Cochrane)). Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. Odds ratios (ORs) were calculated from monthly infection rates and a pooled OR was generated using the DerSimonian and Lairds method. A protocol for this review was registered with the National Institute for Health Research International Prospective Register of Systematic Reviews (CRD42017081871). RESULTS Eighteen studies analysing over 19 000 cases of orthopaedic related infection met inclusion criteria. Data on 6620 cases and 9035 controls from 12 studies were included for meta-analysis. The pooled OR indicated an overall increased odds of post-operative infection for patients undergoing orthopaedic procedures during warmer periods of the year (pooled OR 1.16, 95% confidence interval 1.04-1.30). CONCLUSION A small but significantly increased odds of post-operative infection may exist for orthopaedic patients who undergo procedures during higher temperature periods. It is hypothesized that this effect is geographically dependent and confounded by meteorological factors, local cultural variables and hospital staffing cycles.
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Affiliation(s)
- Mark L Vickers
- Biomedical Engineering and Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Marie Tran
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, The University of Queensland, Brisbane, Queensland, Australia
| | - Mohamad Assoum
- Centre for Child Health Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Patrick N Harris
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Pathology Queensland, Central Laboratory, Brisbane, Queensland, Australia
| | - Anjali Jaiprakash
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Benjamin Parkinson
- School of Medicine, James Cook University, Townsville, Queensland, Australia.,Department of Orthopaedics, Cairns Base Hospital, Cairns, Queensland, Australia
| | - Joel Dulhunty
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Research and Medical Education, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Ross W Crawford
- Biomedical Engineering and Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Orthopaedics Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
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