Management of acute bursitis: outcome study of a structured approach

In patients with septic bursitis the indications for admission and surgical intervention remain unclear, and practice has varied widely. The effective ness of a conservative outpatient based approach was assessed by an outcome study in a prospective case series, Consecutive patients attending an emer gency department with acute swelling of the olecranon or prepatellar bursa were managed according to a structured approach, subjective and objective o utcomes being assessed after two to three days, and subsequently as require d until clinical discharge. Long-term outcomes were assessed by telephone f ollow-up for up to eighteen months, 47 patients were included in the study: 22 had septic bursitis, 15 of the olecranon bursa and 7 of the prepatellar bursa. The mean visual analogue pain scores of those with septic bursitis improved from 4.8 at presentation to 1,7 at first follow-up for olecranon bursitis, and from 3.8 to 2.7 for prepatellar bursitis. Symptoms improved more slowl y for patients with non-septic bursitis. No patients were admitted initiall y, but 2 were admitted (two days each) after the first follow-up appointmen t. One patient had incision and drainage on the third attendance, and 3 pat ients developed discharging sinuses, which all healed spontaneously, All pa tients made a good long-term symptomatic recovery and all could lean on the elbow or kneel by the end of the follow-up period. The management protocol, with specific criteria for admission and surgical intervention, thus produced good results with little need for operation or admission.