Clinical Exam for the Diagnosis of Surgical Site Infections
Moderate strength evidence supports that clinical exam (i.e. pain, drainage, fever) is a moderate to strong rule-in test (i.e. high probability of presence of infection, if test is positive) for patients with suspected surgical site infections, but a weak rule-out test.

Patients with suspected surgical site infections should be assessed by a history and physical examination. Specific data were available for a structured history, presence of fever, and persistent wound drainage. One study of moderate evidence by Pons 1999 used a structured interview to evaluate 80 patients undergoing revision total hip arthroplasty of whom 16 patients had proven infection by histology and microbiology culture. A positive clinical examination was the presence of one of the following: current painful joint, history of chronic joint pain; or a history of wound drainage or fever lasting greater than 48 hours in the first month after primary surgery. A positive history had a sensitivity of 0.625 and specificity of 0.98.

One moderate strength study by Bernard 2004 evaluated the presence of fever and persistent drainage against the confirmed infections of positive culture in 230 patients undergoing revision joint surgery. Fever had a sensitivity of 0.53 and specificity of 0.90, and persistent drainage had a sensitivity of 0.53 and specificity of 0.90.


The Future of OrthoGuidelines


The OrthoGuidelines Process