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Using a decision tool to evaluate for osteomyelitis in children.

Jason J Good1, Michael J Rabener, Geoffrey W Fisher

  • 1Jason J. Good practices in the ED at Wright-Patterson Medical Center, Wright Patterson AFB, Ohio. Michael J. Rabener is program director of the US Air Force Emergency Medicine PA DSc residency at the San Antonio (Tex.) Military Medical Center. Geoffrey W. Fisher practices as a Battalion Flight Surgeon with the 2-10 Aviation Helicopter Battalion, 10th Calvary Brigade, Fort Drum, New York. The authors have disclosed no potential conflicts of interest, financial or otherwise.

JAAPA : Official Journal of the American Academy of Physician Assistants
|September 28, 2021
PubMed
Summary

Pediatric osteomyelitis diagnosis can be improved using the Kocher criteria and C-reactive protein levels. These tools help advocate for MRI, aiding in the early detection of this bone infection.

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Area of Science:

  • Pediatric infectious diseases
  • Musculoskeletal imaging
  • Diagnostic criteria development

Background:

  • Osteomyelitis is a frequent pediatric condition requiring prolonged, multidisciplinary care.
  • Long bone infections are historically common, with Staphylococcus aureus as the primary pathogen.

Purpose of the Study:

  • To highlight the utility of specific diagnostic tools in pediatric osteomyelitis.
  • To demonstrate how clinical criteria and biomarkers can support advanced imaging decisions.

Main Methods:

  • Review of a pediatric case presenting with symptoms suggestive of osteomyelitis.
  • Application of the Kocher criteria for clinical assessment.
  • Utilizing C-reactive protein (CRP) as an acute phase reactant marker.

Main Results:

  • The combination of Kocher criteria and CRP levels proved valuable in assessing the likelihood of osteomyelitis.
  • These diagnostic aids supported the decision to proceed with Magnetic Resonance Imaging (MRI).

Conclusions:

  • The Kocher criteria and CRP are effective tools for advocating MRI in suspected pediatric osteomyelitis.
  • Early and accurate diagnosis through these methods can mitigate the impact of this serious bone infection.