External Validation of the RESAS (REnnes Septic Arthritis Score) Septic Arthritis Prognosis Score in an Acute Arthritis Cohort of Less Than 30 Days
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 244
- 试验地点
- 1
- 主要终点
- RESAS (Rennes Septic Arthritis Score)
研究概览
简要总结
Observational study
详细描述
Septic arthritis is a diagnostic emergency for acute arthritis because it is accompanied by an excess of mortality of 11% and frequent functional sequelae in about 50% of cases in the year. However, it remains rare with an estimated annual incidence of 1 to 5/100000, and a prevalence of about 10% in front of an acute arthritis table sent to an emergency department.
The diagnosis is based on the bacteriological culture which finds the presence of a microorganism within the joint. However, only 80% of septic arthritis is bacteriologically documented due to low inoculum, the presence of fragile bacteria (Neisseria sp) or especially untimely antibiotherapy prior to joint puncture.
In addition, the bacteriological culture takes an average of 3 days to become positive, which may delay the implementation of appropriate antibiotic therapy.
It is therefore essential that the clinician can rely on other clinical or biological parameters, reliable and fast for better diagnostic orientation.
A first study: SYNOLACTATES showed the interest of the measurement of glucose and synovial lactate for the diagnosis of septic arthritis with very good performances. A RESAS score (REnnes Septic Arthritis Score) was constructed from these results to assess the likelihood of septic arthritis.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Any acute arthritis less than or equal to 30 days;
- •Achievement of a joint puncture in routine care as part of the diagnostic assessment of this acute arthritis;
- •Affiliation to a social security scheme;
- •No one opposes his participation in the research.
排除标准
- •Age below 18 years;
- •Major persons subject to legal protection (safeguard of justice, guardianship, guardianship), persons deprived of their liberty.
结局指标
主要结局
RESAS (Rennes Septic Arthritis Score)
时间窗: Up to 3 days (time to collect laboratory results)
Composite score of 4 biological variables of the synovial liquid (macroscopically purulent liquid and/or Synovial White Cells Counts (SWCC) ≥ 75000/mm3, synovial crystal vizualization, synovial lactate dosage, synovial glucose dosage). Each variable is weighted as follows: macroscopically purulent liquid or SWCC ≥ 75000/mm3 (+3 points), UMS (-4 points) or CPP (-2 points) crystal Vizualization, lactate ≥ 11.5 mmol/L (+6 points) or 10-11.4 mmol/L (+4 points) or 8.5-9.9 mmol/L (+2 points), glucose ≤ 1.0 mmol/L (+4 points), 1.1-1.8 mmol/L (+2 points), yielding a total between -4 and 13.
次要结局
- Synovial White Cells Count (SWCC)(Up to 3 days (time to collect laboratory results))
- Number of classical clinical marker (quantitative variable) to diagnosis of septic arthritis(Up to 1 day (time to collect clinical parameters))
- Microscopic synovial analysis(Up to 3 days (time to collect laboratory results))
- Multielemental analysis by ICP-MS(Up to 3 days (time to collect laboratory results))
- Number of classical clinical marker (qualitative variable) to diagnosis of septic arthritis(Up to 1 day (time to collect clinical parameters))
- Macroscopic synovial fluid appearance(Up to 1 day (time to collect clinical parameters))
- Total lactates, D-lactate, glucose(Up to 3 days (time to collect laboratory results))
- Others synovial proteic markers(Up to 3 days (time to collect laboratory results))
- Parameters that may influence the bacteriological results of synovial fluid(Up to 1 day (time to collect clinical parameters))
- Number of hospitalization potentially avoided by the early elimination of an arthritis diagnosis and their cost, from the point of view of illness insurance(Date of hospitalization until 2 months of follow-up)