• Eileen Shu, Leyla Farshidpour, Megann Young, Michael Darracq, and Ives Tallman Crystal C UCSF Fresno Department of Emergency Medicine, United States of America. Electronic address: civestallman@fresno.ucsf.edu..
• UCSF Fresno Department of Emergency Medicine, United States of America.
• Am J Emerg Med. 2019 Mar 1; 37 (3): 502-505.

BackgroundSynovial lactate is a promising biomarker to distinguish septic from aseptic arthritis. If available as a point-of care test, synovial lactate would be rapidly available to aid the emergency provider in clinical decision making. This study assesses the test characteristics of synovial lactate obtained using an EPOC© point-of-care (POC) analyzer to rapidly distinguish septic from aseptic arthritis in the emergency department.MethodsWe enrolled a convenience sample of patients with possible septic arthritis presenting to the emergency department at a large urban academic center between October 2016 and April 2018. Enrolled patients underwent arthrocentesis based on the clinical judgment of the treating provider. We obtained synovial lactate levels (SLL) from the POC device. Standard laboratory analysis, synovial fluid culture, emergency and hospital course, operative procedures, antibiotics, and discharge diagnosis were abstracted from the electronic medical record.ResultsThirty-nine patients undergoing forty separate arthrocentesis procedures were enrolled in this study over the two-year period. The sensitivity and specificity of SLL ≥ 5 mmol/L was 0.55 and 0.76 respectively, with +LR 2.3 and -LR 0.6. The sensitivity and specificity of SLL ≥ 10 mmol/L was 0.27 and 0.97 respectively, with +LR 7.9 and -LR 0.8; SLL ≥ 10 mmol/L performed similarly to overall synovial WBC ≥ 50,000/μL by conventional laboratory testing.ConclusionIt is feasible to obtain a synovial lactate level using the EPOC© POC device. In our study, POC SLL performs similarly to other markers used to diagnose septic arthritis. Further study with larger sample sizes is warranted.Copyright © 2018. Published by Elsevier Inc.

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