Limp Hip Pain algo v1

  • Patient presents with irritable hip
    • Full VS; ibuprofen at triage
      • Perform H&P
        • X-ray bilateral (AP/frog leg pelvis)
          • Bones Normal?
            • No
              • Ortho consult
            • Yes
              • Need to perform labs?
                • No
                  • Consider lyme D/C home with instructions (nsaids, criteria for return, follow-up in 24 hrs)
                  • Contact primary care physical for follow-up
                • Yes
                  • Order: cbc, esr, crp, lyme; blood culter if febrile or no h/o fever
                    • Meets criteria for ultrasound?
                      • No
                        • Consider lyme D/C home with instructions (nsaids, criteria for return, follow-up in 24 hrs)
                        • Contact primary care physical for follow-up
                      • Yes
                        • Obtain hip ultrasound
                          • Is effusion present?
                            • No
                              • Exit algorithm for further evaluation
                            • Yes
                              • Persistent clinical concern for septic arthritis?
                                • No
                                  • Consider lyme D/C home with instructions (nsaids, criteria for return, follow-up in 24 hrs)
                                  • Contact primary care physical for follow-up
                                • Yes
                                  • Hip arthrocentesis Strongly consider ortho consult
                                    • Concern for possible septic arthritis
                                      • No
                                        • Notify/discuss with ortho if diagnostic uncertainty.
                                        • D/C home with instructions (nsaids, criteria for return, follow-up in 24 hrs)
                                        • Contact primary care physician
                                      • Yes
                                        • Go to septic arthritis CPG

Leave a Comment