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Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation
Neeraj Vij1, Ian Singleton2, Paul Kang3
1University of Arizona College of Medicine.
Insights
The A-SCORE and C-SCORE effectively predict acute complications and chronic morbidity in pediatric acute hematogenous osteomyelitis (AHO). These scores aid clinicians in stratifying risk and guiding early treatment decisions for AHO patients.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Clinical Risk Stratification
Background:
- Pediatric acute hematogenous osteomyelitis (AHO) outcomes depend on disease severity.
- A-SCORE and C-SCORE predict acute complications and chronic morbidity, respectively.
- External validation of these scores is crucial for clinical application.
Purpose of the Study:
- To externally validate the A-SCORE and C-SCORE in a single institution.
- To assess the predictive accuracy of A-SCORE for acute complications.
- To assess the predictive accuracy of C-SCORE for chronic morbidity.
Main Methods:
- Retrospective chart review of AHO patients (ages 0-18) from October 2015 to December 2019.
- Inclusion criteria: clinical response to treatment; Exclusion criteria: immunocompromised status or penetrating injury.
- Level III prognostic study.
Main Results:
- A-SCORE showed high accuracy (ROC area >86%) for acute complications, with sensitivity >85% and specificity >92% at a cut-off of 4.
- C-SCORE demonstrated excellent accuracy (ROC area 100%) for chronic osteomyelitis, with sensitivity >70% and specificity >93% at a cut-off of 3.
- Both scores proved effective in predicting outcomes in the studied pediatric AHO population.
Conclusions:
- A-SCORE and C-SCORE are valuable tools for risk stratification in pediatric AHO management.
- These scores, combined with clinical judgment, can guide early care decisions.
- Integration into standardized guidelines can improve clinical decision-making for AHO patients.
Background:
Pediatric acute hematogenous osteomyelitis (AHO) outcomes are highly dependent on the disease severity. Recently, the A-SCORE and C-SCORE, were proposed as predictors of an acute complicated course and chronic morbidity, respectively. The purpose of this study was to externally validate the A-SCORE and C-SCORE at a single institution.
Methods:
This IRB-approved retrospective chart review included AHO patients admitted at a tertiary referral hospital between October 1, 2015 and December 31, 2019. The inclusion criteria were ages 0 to 18 and clinical response to treatment. The exclusion criteria were immunocompromised status or penetrating inoculation.
Results:
The A-SCORE demonstrated an area under the receiver operator curve (ROC area) of >86% with regards to all acute complications. It also demonstrated sensitivities >85% and specificities >92% at the cut-off of 4 (Youden index) for all acute complications. The C-SCORE demonstrated an ROC area of 100% with regards to chronic osteomyelitis. It also demonstrated sensitivities >70% and specificities >93% for the chronic morbidity variables seen in our population at the cut-off of 3 (Youden index.).
Conclusions:
These novel composite clinical scores, in combination with clinical judgment, could help guide early care decisions. The A-SCORE and C-SCORE are useful risk stratification tools in the management of pediatric AHO and in predicting acute complicated courses or chronic sequelae of AHO, respectively. These scoring systems, if integrated into standardized pediatric AHO guidelines, can allow clinicians to stratify the AHO population and guide clinical decision making.
Level Of Evidence:
Level III (prognostic study, retrospective chart review).
