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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.
Insights
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.
Background:
There is increasing recognition that deep venous thrombosis (DVT) is a complicating factor in some children with acute hematogenous osteomyelitis. The similarity in signs and symptoms of osteomyelitis and DVT make clinical recognition of this complicating condition difficult. It would be helpful to the clinician to identify by other means which children with osteomyelitis are at greatest risk for DVT. We reviewed the available literature regarding osteomyelitis and DVT in children to identify potential characteristics of children with osteomyelitis that puts them at risk for concurrent DVT.
Methods:
We performed searches of the PubMed, Cochrane, CINAHL, and National Guideline Clearinghouse databases on the topic of osteomyelitis and thrombosis in children 0 to 18 years of age from 2001 to the present.
Results:
Four studies were included: 3 retrospective and 1 prospective. Studies varied in terms of clinical, laboratory, and imaging parameters evaluated. Overall they suggest trends toward increased incidence of DVT in children who were critically ill at presentation, had positive blood cultures, were infected with methicillin-resistant Staphylococcus aureus, had an elevated C-reactive protein, and had central venous catheters placed.
Conclusions:
Strong consideration should be given to evaluating children with osteomyelitis for DVT if they are critically ill at presentation, particularly if they have pulmonary findings, are persistently bacteremic, especially with methicillin-resistant S aureus.
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