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The Osteoarticular Infection in a Pediatric Emergency Setting: A Challenging Diagnosis
Elena Boccuzzi1, Danilo Buonsenso2,3, Valentina Ferro1
1From the Pediatric Emergency Department, Bambino Gesù Children's Hospital.
Insights
Diagnosing pediatric osteoarticular infections in the emergency department (ED) is challenging due to non-specific signs and normal initial tests. Early recognition is crucial to prevent long-term bone damage.
Area of Science:
- Pediatric Emergency Medicine
- Musculoskeletal Infections
- Diagnostic Challenges
Background:
- Osteoarticular infections in children, including osteomyelitis and septic arthritis, present diagnostic difficulties in emergency settings.
- Delayed or missed diagnoses can lead to significant clinical and bone structural sequelae.
Purpose of the Study:
- To evaluate the emergency department (ED) presentation of pediatric patients diagnosed with osteomyelitis, septic arthritis, or both.
- To identify factors influencing diagnostic accuracy and patient outcomes.
Main Methods:
- Retrospective single-center study of 117 children (1 month to 18 years) with osteoarticular infections over 7 years.
- Analysis of clinical presentation, laboratory findings, imaging results, and diagnostic timeliness.
Main Results:
- Only 39.3% of patients were admitted after initial ED evaluation, with 45.3% receiving an accurate diagnosis upon admission.
- Pain was the sole consistent symptom; laboratory and X-ray findings were often non-specific or unremarkable.
- Clinical sequelae occurred in 19.23% and bone structural sequelae in 56.86% of cases.
- Timely diagnosis (within 1 week) correlated with better clinical manifestations and fewer osteolytic findings.
Conclusions:
- Pediatric osteoarticular infections pose diagnostic challenges in the ED due to atypical presentations and non-specific investigations.
- The lack of classic signs, normal lab values, and unremarkable imaging contribute to diagnostic delays.
- Prompt recognition and treatment are essential to minimize long-term complications.
Objectives:
The study aimed to evaluate the emergency department (ED) presentation of children with a diagnosis of osteomyelitis, septic arthritis, or both.
Methods:
A retrospective single-center study was conducted on all children aged between 1 month and 18 years evaluated in the ED over a 7-year period and having a final diagnosis of osteoarticular infection. One hundred seventeen patients were enrolled.
Results:
Only 39.3% of patients were admitted after the first evaluation, and only 45.3% had a proper diagnosis of admission. Pain was the only symptom reported by all. White cell count, C-reactive protein level, and erythrocytes sedimentation rate were normal in 49.5%, 21.4%, and 17.1% of children, respectively. X-ray findings were unremarkable in 48% of cases. Clinical and bone structural sequelae were described in 19.23% and 56.86% of all cases. No statistically significant differences were found among osteomyelitis, arthritis, and the combination of both regarding all considered variables, except for structural outcomes resulting more significant in the third group. Significant differences were evident in clinical manifestations, blood examinations, and findings of osteolysis between patients diagnosed within and after 1 week since the disease onset. Finally, questionable differences between white blood cells and C-reactive protein level were found among patients younger than 5 years and older ones, whereas a history of trauma was more often reported in the second group.
Conclusions:
The difficulty in recognizing osteoarticular infection in a pediatric ED can be due to the possible lack of the classic signs and symptoms, and the absence of specific laboratory and radiologic findings.
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