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When should DVT be suspected in children with osteomyelitis?
Mary G Altobelli1, Ricardo A Quinonez
1Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Hospital Pediatrics
|December 11, 2013
Summary
Children with osteomyelitis face a risk of deep venous thrombosis (DVT). Critically ill children, especially those with certain infections or positive blood cultures, require careful DVT evaluation.
Area of Science:
- Pediatric Hematology
- Pediatric Infectious Diseases
- Vascular Medicine
Background:
- Deep venous thrombosis (DVT) is an emerging complication in pediatric acute hematogenous osteomyelitis.
- Clinical signs of osteomyelitis and DVT overlap, complicating diagnosis.
- Identifying children with osteomyelitis at higher risk for DVT is clinically important.
Purpose of the Study:
- To review the literature and identify risk factors for DVT in children diagnosed with osteomyelitis.
- To aid clinicians in assessing DVT risk in pediatric osteomyelitis cases.
Main Methods:
- Systematic literature search of PubMed, Cochrane, CINAHL, and National Guideline Clearinghouse databases.
- Inclusion of studies on osteomyelitis and thrombosis in children aged 0-18 years from 2001 to present.
- Analysis of clinical, laboratory, and imaging parameters from included studies.
Main Results:
- Four studies (3 retrospective, 1 prospective) met inclusion criteria.
- Trends suggest increased DVT incidence in critically ill children with osteomyelitis.
- Risk factors include positive blood cultures, methicillin-resistant Staphylococcus aureus (MRSA) infection, elevated C-reactive protein, and central venous catheter use.
Conclusions:
- Children with osteomyelitis presenting as critically ill should be evaluated for DVT.
- Particular attention is warranted for those with pulmonary findings or persistent bacteremia, especially with MRSA.
- Early DVT evaluation can improve outcomes in at-risk pediatric osteomyelitis patients.
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