Development of a simple diagnostic tool predicting the aseptic nature of a joint effusion: a pragmatic pilot study
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Arthur Vrignaud
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Guillaume Direz
Abstract
Objectives
Among all of the swollen joints undergoing an aspiration in primary care, approximately 92 % are of nonseptic cause. This study therefore sought to develop a predictive model, based on simple clinical and paraclinical data, with the aim of predicting the aseptic nature of joint effusion.
Methods
This is a cohort, prospective, monocentric study. Some explanatory variables were predetermined on the basis of the literature review. A predictive model has been established based on these variables. In order to prioritise the negative predictive value, a cut-off point considering the best specificity for an observed sensitivity greater than or equal to 98 % was retained.
Results
A total of 328 participants, 49.1 % of whom were women, were included in this study, with a median age of 69 years. The median duration of evolution of joint effusion before the puncture was 30 days. Joint fluid had inflammatory characteristics in 46.0 % of cases and 8 septic arthritis were identified. The area under the receiver operating characteristic (ROC) curve of the predictive model was evaluated at 0.93. The model includes the maximum temperature, the polyarticular nature of the clinical picture and the macroscopic appearance of the joint fluid.
Conclusions
This study made it possible to develop a simple and easily accessible predictive model in a primary care setting. This tool could make it possible to exclude a priori the septic aetiology of one out of four native joint effusions. Its performances remain to be determined on an independent population in a subsequent study (confirmation cohort in progress).
Acknowledgments
The authors acknowledge Clémentine LELEU, Jean-Maxime PIOT, Romain BRIER, Sabine HOEFSLOOT, Jérémy CHATELAIS, Clémence VERNIER and Bénédicte HAETTICH for their participation in the inclusion and their monitoring participants in this clinical study.
The authors also thank Christelle JADEAU, Eglantine ROUANET, Morgane GOULVENT, Céline LAGRANGE and Jean-François HAMEL for their support in the investigation and statistical analyses of this research protocol.
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Research ethics: The study protocol has been evaluated and obtained the agreement of the “CPP Sud-Ouest et Outre-Mer III” on the 21st January 2020.
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Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. AV: conceptualization, methodology, validation, formal analysis, investigation, data curation, writing, visualization, supervision, project administration. GD: conceptualization, methodology, investigation, writing, visualization. AD: conceptualization, methodology, investigation, writing, visualization. ED: conceptualization, methodology, validation, investigation, resources, writing, visualization, supervision, project administration.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: The datasets used and/or analysed for the current study are available from the corresponding author on reasonable request.
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