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Contiguous Osteomyelitis of Distal Extremities in Children
Akshay Vivek Nandavar1, Talya Toledano1, Catalina Marino1
1Lincoln Medical and Mental Health Center, Bronx, NY, USA.
Insights
Contiguous osteomyelitis (COM) in children with hand/foot infections is often missed clinically. Imaging is crucial for diagnosing COM in pediatric patients hospitalized with cellulitis or abscess, guiding appropriate antibiotic treatment.
Area of Science:
- Pediatric infectious diseases
- Musculoskeletal infections
- Diagnostic imaging
Background:
- Cellulitis and abscesses of the hands and feet are common in children.
- Distinguishing these superficial infections from deeper bone infections like contiguous osteomyelitis (COM) can be challenging.
- Early and accurate diagnosis of COM is essential for effective treatment and preventing complications.
Purpose of the Study:
- To determine the prevalence and diagnostic challenges of contiguous osteomyelitis (COM) in pediatric patients presenting with cellulitis or abscess of the hands or feet.
- To identify clinical factors that differentiate COM from superficial infections in this population.
- To assess the role of imaging in diagnosing COM in pediatric distal extremity infections.
Main Methods:
- Retrospective chart review of pediatric patients (0-18 years) treated for hand/foot cellulitis/abscess between 2009-2019.
- Inclusion criteria: MRI at presentation or X-ray >10 days post-symptom onset.
- Statistical analysis using a two-tailed T-test to compare groups with and without COM.
Main Results:
- Twenty out of forty-one pediatric patients with distal extremity abscess/cellulitis were diagnosed with COM.
- No significant differences were found between COM and non-COM groups regarding trauma-to-presentation time, prior antibiotic use, infection type (abscess vs. cellulitis), location, fever, or general signs of infection.
- Imaging modalities were instrumental in diagnosing COM in these patients.
Conclusions:
- Clinical presentation alone is insufficient to differentiate contiguous osteomyelitis (COM) from cellulitis/abscess in pediatric distal extremity infections.
- Imaging plays a vital role in identifying COM, potentially preventing under-treatment with shorter antibiotic courses.
- Consideration of hand/foot imaging for hospitalized pediatric patients with cellulitis/abscess is recommended to ensure accurate COM diagnosis and tailored treatment.
Abstract:
Objective. To evaluate the burden of Contiguous Osteomyelitis (COM) in pediatric patients with cellulitis/abscess of hands/feet. Methods. Children aged 0-18 years, treated from 2009 to 2019 for cellulitis/abscess of hands/feet, who either had Magnetic Resonance Imaging at presentation, or Roentgenogram >10 days after symptom-onset, were included. Two-tailed T-test was used to compare patients with and without COM. P-value < .05 deemed statistically significant. Results. Twenty of forty-one patients with abscess/cellulitis of distal extremities were diagnosed with COM. Between groups, no differences identified in trauma-to-presentation time, antibiotic treatment for >48 hours before admission, abscess versus cellulitis, location of infection, presence of fever, or signs of infection. Conclusion. In our cohort, clinical presentation did not differentiate COM. Imaging helped diagnose patients with COM, who would otherwise receive a shorter antibiotic course. Hands/feet imaging in pediatric patients hospitalized with cellulitis/abscess should be considered to identify COM and customize treatment. Further research is warranted.
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