Clinical Presentation of Acute Osteomyelitis in the Pediatric Emergency Department
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Published on: February 9, 2011
Alexander M Stephan1, Anna Faino2, Derya Caglar1
1From the Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine.
Insights
Pediatric osteomyelitis diagnosis in the emergency department is challenging, as fever is often absent. Key symptoms include pain and functional limitation, with elevated inflammatory markers aiding diagnosis.
Area of Science:
- Pediatric Emergency Medicine
- Orthopedic Infectious Diseases
- Diagnostic Challenges in Pediatrics
Background:
- Acute osteomyelitis in children presents a diagnostic challenge in pediatric emergency departments due to variable symptoms.
- Understanding presenting features is crucial for timely and accurate diagnosis of pediatric osteomyelitis.
- Limited data exists on the specific clinical manifestations of acute osteomyelitis in children presenting to emergency care.
Purpose of the Study:
- To describe clinical data contributing to the diagnosis of acute osteomyelitis in children.
- To identify key presenting features in pediatric patients with acute osteomyelitis.
- To inform diagnostic decision-making in pediatric emergency departments.
Main Methods:
- Retrospective cohort study over 10 years at a tertiary care children's hospital.
- Included patients aged 18 years or younger diagnosed with acute osteomyelitis in the emergency department.
- Data collected: demographics, clinical history, symptoms, vital signs, physical exam, laboratory, microbiologic, and imaging results.
Main Results:
- 211 cases of acute osteomyelitis identified; median age 8.4 years, 61.1% male.
- 60.2% of patients had multiple visits before diagnosis.
- Common symptoms: pain (94.3%), functional limitation (83.9%), fever (76.3%). Common findings: functional limitation (78.2%), focal tenderness (73.5%), swelling (52.1%).
- Elevated C-reactive protein (92.9%) and erythrocyte sedimentation rate (94.3%) were highly sensitive markers.
Conclusions:
- Fever may be absent in nearly a quarter of pediatric acute osteomyelitis cases.
- Inflammatory marker elevations, while sensitive, were less pronounced than in pediatric septic arthritis.
- Diagnostic vigilance is required, considering symptom variability and potential absence of fever.
Objectives:
Acute osteomyelitis is a challenging diagnosis to make in the pediatric emergency department (ED), in part because of variability in its presentation. There are limited data detailing the presenting features of pediatric osteomyelitis, factors that are essential to understand to inform diagnostic decision making. We sought to describe relevant clinical data that contributed to the diagnosis of acute osteomyelitis in children presenting to a pediatric ED.
Methods:
This was a 10-year retrospective cohort study of patients 18 years or younger diagnosed with acute osteomyelitis in the ED of a large tertiary care children's hospital. Collected data included demographics, clinical history, patient-reported symptoms, vital signs, physical examination findings, and results of basic laboratory, microbiologic, and imaging studies. Descriptive statistics were used to summarize key findings.
Results:
Two hundred eleven cases of acute osteomyelitis were identified during the study period. The median age was 8.4 years, with 61.1% male. One hundred twenty-seven patients (60.2%) presented to care more than once before being diagnosed. Common symptoms included pain (94.3%), functional limitation (83.9%), and fever (76.3%). Common examination findings included functional limitation (78.2%), focal tenderness (73.5%), and swelling (52.1%). One hundred seventeen patients (55.5%) were febrile during their ED evaluation. Elevated C-reactive protein (>0.8 mg/dL, 92.9%) and erythrocyte sedimentation rate (>10 mm/h, 94.3%) were the most sensitive laboratory markers.
Conclusions:
Fever may be absent in up to a quarter of pediatric patients with acute osteomyelitis. Although highly sensitive, inflammatory marker elevations were more modest than those reported previously in cases of pediatric septic arthritis.
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