Kocher criteria

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The Kocher criteria are a tool useful in the differentiation of septic arthritis from transient synovitis in the child with a painful hip. They are named for Mininder S. Kocher, M.D., M.P.H., an orthopaedic surgeon at Boston Children's Hospital and Professor of Orthopaedic Surgery at Harvard Medical School.

The original study used retrospective pediatric cases to develop the criteria over multiple years. The score is primarily used in orthopedic cases in which the symptoms experienced in septic arthritis and transient synovitis are similar.[1] The criteria can be used on multiple joints — the hip being the most tested given its frequency of diagnosis and importance to the patient's mobility. The knee and the ankle can also experience these symptoms and the criteria can be applied to symptomatic joints such as these.[2] Septic arthritis is an orthopedic emergency, which, if treatment is delayed, can lead to irreversible joint damage. Septic arthritis occurs more often in childhood than at any other time.[3]


A point is given for each of the four following criteria:

Score Likelihood of septic arthritis
1 3%
2 40%
3 93%
4 99%

See also[edit]


  1. ^ Kocher MS, Zurakowski D, Kasser JR (1999). "Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm". J Bone Joint Surg Am. 81 (12): 1662–70. doi:10.2106/00004623-199912000-00002. PMID 10608376. 
  2. ^ R. Singhal; D.C. Perry; C.E. Bruce. (2012). "The Diagnostic Utility of Kocher's Criteria in the Diagnosis of Septic Arthritis in Children: An External Validation Study". J Bone Joint Surg. 94–B (XXXV 6). 
  3. ^ Bruce Jancin. "Kocher Criteria Still the Best Way To ID Septic Arthritis in Children". ACEP. Retrieved 2014-10-17.