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Paeds Casesrheumatology-musculoskeletal-and-sports

Paeds Cases · rheumatology-musculoskeletal-and-sports

Explain the Kocher prediction rule to a family with an irritable hip — OSCE

OSCE communication and shared decision-making station: explaining the assessment and management of a suspected septic hip to the parents of a five-year-old boy, addressing the Kocher prediction rule in plain language, the need for urgent aspiration and washout, the reassurance about transient synovitis when the score is low, and the plan for follow-up.

osce communication and shared decision-making2 min readVerification in progress

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
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Study tools

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
The parents of a five-year-old boy are in the emergency department after he woke with a fever of 39 degrees and refused to walk, holding his right leg still. The registrar suspects septic arthritis based on a high Kocher score and has arranged a hip ultrasound and orthopaedic review. The parents are frightened, they think the limp is from the fall he had at the playground yesterday, and they do not understand why their child needs a needle in his hip and possibly an operation. Counsel them.

Candidate brief

You have eight minutes to counsel the parents of a five-year-old boy who is suspected to have a septic hip, confirmed by a high Kocher score, a hip ultrasound showing an effusion, and an elevated C-reactive protein. Use a structured, honest, empathic approach that explains the problem in plain language, addresses the parents' fears and the playground theory, and builds a shared plan for the aspiration and the possible operation. [4] [8]

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References3ShowHide
  1. [4]Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. Journal of Bone and Joint Surgery. American Volume, 1999.PMID 10608376
  2. [7]Payares-Lizano M. The limping child. Pediatric Clinics of North America, 2020.PMID 31779828
  3. [8]Adamson J, Waterfield T. Fifteen-minute consultation: the limping child. Archives of Disease in Childhood. Education and Practice Edition, 2020.PMID 31255998
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