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Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a
Øystein Rolandsen Riise1, Eva Kirkhus, Kai Samson Handeland
1Department of Paediatrics, Ullevål University Hospital, Oslo, Norway. oystein.riise@rikshospitalet.no
Insights
The annual incidence of pediatric osteomyelitis in Norway is 13 per 100,000, with higher rates in young children. Magnetic Resonance Imaging (MRI) and Erythrocyte Sedimentation Rate (ESR) aid in diagnosis.
Area of Science:
- Pediatric infectious diseases
- Musculoskeletal infections
- Epidemiology
Background:
- Osteomyelitis diagnosis in children is challenging, lacking prospective identification methods in defined regions.
- This study aimed to establish incidence, describe patient/disease characteristics, and differentiate osteomyelitis from other musculoskeletal conditions in children.
Purpose of the Study:
- Assess the annual incidence of pediatric osteomyelitis.
- Characterize acute (<14 days) and subacute (>=14 days) osteomyelitis.
- Differentiate osteomyelitis from other acute musculoskeletal disorders.
Main Methods:
- Population-based prospective study in Norway.
- Physician referral of suspected pediatric osteomyelitis cases.
- Standardized follow-up protocols at 6 weeks, 6 months, and as needed.
Main Results:
- Overall incidence: 13/100,000 annually (8 acute, 5 subacute).
- Higher incidence in children <3 years (OR 2.9). Non-vertebral osteomyelitis more common than vertebral (10 vs. 3/100,000).
- MRI positive predictive value: 85%; ESR >40 mm/hr: 26%. Acute osteomyelitis showed higher inflammatory markers and positive blood cultures (26%) compared to subacute.
Conclusions:
- Pediatric osteomyelitis incidence in Norway remains significant.
- ESR and MRI are valuable tools for identifying osteomyelitis and distinguishing between acute and subacute forms.
Background:
Osteomyelitis can be difficult to diagnose and there has previously not been a prospective approach to identify all children in a defined geographic area. The aim of this study was to assess the annual incidence of osteomyelitis in children, describe the patient and disease characteristics in those with acute (< 14 days disease duration) and subacute osteomyelitis (> or = 14 days disease duration), and differentiate osteomyelitis patients from those with other acute onset musculoskeletal features.
Methods:
In a population-based Norwegian study physicians were asked to refer all children with suspected osteomyelitis. Children with osteomyelitis received follow-up at six weeks, six months and thereafter as long as clinically needed.
Results:
The total annual incidence rate of osteomyelitis was 13 per 100,000 (acute osteomyelitis 8 and subacute osteomyelitis 5 per 100,000). The incidence was higher in patients under the age of 3 than in older children (OR 2.9, 95%: CI 2.3-3.7). The incidence of non-vertebral osteomyelitis was higher than the incidence of vertebral osteomyelitis (10 vs. 3 per 100 000; p = .002). Vertebral osteomyelitis was more frequent in girls than in boys (OR 7.0, 95%: CI 3.3-14.7). ESR > or = 40 mm/hr had the highest positive predictive laboratory value to identify osteomyelitis patients at 26% and MRI had a positive predictive value of 85%. Long-bone infection was found in 16 (43%) patients. ESR, CRP, white blood cell count, neutrophils and platelet count were higher for patients with acute osteomyelitis than for patients with subacute osteomyelitis. Subacute findings on MRI and doctor's delay were more common in subacute osteomyelitis than in acute osteomyelitis patients. Blood culture was positive in 26% of the acute osteomyelitis patients and was negative in all the subacute osteomyelitis patients.
Conclusion:
The annual incidence of osteomyelitis in Norway remains high. ESR values and MRI scan may help to identify osteomyelitis patients and differentiate acute and subacute osteomyelitis.
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