Referral criteria from primary care - prepatellar bursititis

Admission or referral

Criteria for admission to hospital

• if septic bursitis, and:
  • extensive cellulitis, or
  • severe infection or
  • systemic toxicity, including high fever, or
  • development of an abscess - requires incision and drainage
    
    
• if there is clinical suspicion of infection of the underlying knee join (septic knee joint)
  • if there is a limitation in range of movement of knee join - unlike in septic bursitis
    
    
• if patient is immunocompromised or has other medical conditions, such as rheumatoid arthritis or diabetes (1)

Possible hospital admission or need for specialist advice

• if the person has no response, or an inadequate response, to an antibiotic in septic bursitis
  • refer urgently or seek specialist advice
    • a change in antibiotic, intravenous antibiotic, or incision and drainage may be required
      
      
• refer for expert assessment if:
  • recurrent septic bursitis - may be need for surgical excision of bursa after resolution of infection
  • a chronic discharging sinus - surgical excision may be indicated
  • non septic chronic bursitis
    • which does not respond to primary care management, or with significant recurrent swelling and/or pain

Reference:

• NICE CKS - Pre-patellar bursitis (Accessed 15/5/2019)
• Baumbach SF et al. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm.Arch Orthop Trauma Surg. 2014 Mar;134(3):359-70
• Primary Care Rheumatology Society (PCRS). Joint and soft tissue Injection guidelines PCRS (Updated 2017)