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Predictors of Outcome in Pediatric Osteomyelitis: Five Years Experience in a Single Tertiary Center
Andrew C Martin1, Denise Anderson, Julie Lucey
1From the *Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Australia; †School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia, ‡Telethon Kids Institute, Perth, Australia; §Department of Orthopaedic Surgery, Princess Margaret Hospital for Children, Perth, Australia; ¶Murdoch Childrens Research Institute, Parkville, Australia; ‖Department of Paediatrics, University of Melbourne, Parkville, Australia; **Department of Paediatrics, Monash University, Clayton, Australia; ††PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, Perth, Australia; and ‡‡Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia.
Insights
Predicting complicated osteomyelitis in children is challenging. A simple risk model using admission data like age and C-reactive protein can identify high-risk pediatric patients early.
Area of Science:
- Pediatric infectious diseases
- Bone infections
- Clinical risk prediction
Background:
- Acute haematogenous osteomyelitis is a common bone infection in children.
- Most children recover well, but some develop complicated disease, posing a diagnostic challenge.
- Early identification of complicated osteomyelitis is crucial, especially with short hospital stays.
Purpose of the Study:
- To identify predictors of complicated acute haematogenous osteomyelitis in children.
- To develop a risk prediction model for complicated pediatric osteomyelitis.
- To enable early identification of children at high risk for severe outcomes.
Main Methods:
- Retrospective review of case notes for children aged 3 months to 16 years diagnosed with acute haematogenous osteomyelitis.
- Comparison of clinical and laboratory parameters between simple and complicated osteomyelitis cases.
- Analysis of 299 pediatric patients over a 5-year period.
Main Results:
- 80.6% of children had simple osteomyelitis, while 19.4% developed complicated disease.
- Key predictors for complicated osteomyelitis included older age, fever >38.5°C, and elevated C-reactive protein (CRP) on admission.
- These factors were identified from standardized clinical and laboratory data.
Conclusions:
- A risk prediction model using readily available admission data can effectively identify children at high risk for complicated osteomyelitis.
- Early risk stratification allows for timely intervention and tailored management strategies.
- This model aids clinicians in developed countries with short hospitalizations to manage pediatric osteomyelitis.
Background:
Acute haematogenous osteomyelitis is a bacterial infection of bone, which occurs most frequently in children. Outcomes are excellent for the majority of children, but a minority develop complicated osteomyelitis. Predicting which children will develop complicated osteomyelitis remains a challenge, particularly in developed countries where most patients are discharged home after a relatively short period in hospital.
Methods:
We conducted a 5-year retrospective case note review of all children aged 3 months to 16 years admitted with a diagnosis of acute haematogenous osteomyelitis. We compared standardized clinical and laboratory parameters in those who developed simple and complicated osteomyelitis.
Results:
Of the 299 children who met inclusion, 241 (80.6%) had simple and 58 (19.4%) had complicated osteomyelitis. The major predictors of complicated disease were older age, a temperature greater than 38.5°C and a higher C-reactive protein at admission.
Conclusions:
A risk prediction model, utilizing information available shortly after hospitalization, allows early identification of children at greatest risk of developing complicated osteomyelitis.
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