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Early CRP Trends in Childhood Osteomyelitis Predict Complicated Disease
1Department of Orthopaedic Surgery, University of Auckland, Waikato Hospital, Waikato, New Zealand.
Insights
C-reactive protein (CRP) trends in children with acute hematogenous osteomyelitis (AHO) can predict severe disease. Failure to reduce CRP by 50% within 4-5 days indicates a higher risk of acute or chronic complications.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Biomarkers in Medicine
Background:
- Acute hematogenous osteomyelitis (AHO) is a significant pediatric illness.
- Predicting acute and chronic complications is crucial for patient management.
- C-reactive protein (CRP) trends may indicate disease progression in AHO.
Purpose of the Study:
- To identify factors predicting acute and chronic complications of AHO in children.
- To analyze the association between CRP trends and disease outcomes.
- To investigate the New Zealand pediatric population for AHO complication predictors.
Main Methods:
- Retrospective review of pediatric AHO cases (2008-2018) at a tertiary center.
- Multivariate analysis to identify predictors of acute and chronic complications.
- Defined acute complications (e.g., multiple surgeries, prolonged hospitalization) and chronic complications (e.g., growth discrepancy, chronic osteomyelitis).
Main Results:
- 151 pediatric AHO cases were analyzed; 34% had acute complications, 12% had chronic complications.
- Predictors of acute complications included contiguous disease, delayed presentation, and inadequate CRP reduction (50% by day 4/5).
- Chronic complications were associated with surgical management and inadequate CRP reduction.
Conclusions:
- CRP trends within 96 hours of treatment initiation can distinguish children with AHO at risk for severe disease.
- Early identification of inadequate CRP response is key to predicting complicated AHO cases.
- This finding aids in tailoring treatment and monitoring for severe outcomes in pediatric AHO.
Background:
Acute hematogenous osteomyelitis (AHO) remains a cause of severe illness among children. Contemporary research aims to identify predictors of acute and chronic complications. Trends in C-reactive protein (CRP) after treatment initiation may predict disease course. We have sought to identify factors associated with acute and chronic complications in the New Zealand population.
Methods:
A retrospective review of all patients younger than16 years with presumed AHO presenting to a tertiary referral centre between 2008 and 2018 was performed. Multivariate was analysis used to identify factors associated with an acute or chronic complication. An "acute" complication was defined as the need for 2 or more surgical procedures, a hospital stays longer than 14 days, or recurrence despite intravenous antibiotics. A "chronic" complication was defined as growth or limb length discrepancy, avascular necrosis, chronic osteomyelitis, pathologic fracture, frozen joint, or dislocation.
Results:
One hundred fifty-one cases met the inclusion criteria. The median age was 8 years (69.5% male). Within this cohort, 53 (34%) experienced an acute complication and 18 (12%) a chronic complication. Regression analysis showed that contiguous disease, delayed presentation, and failure to reduce CRP by 50% at day 4/5 predicted an acutely complicated disease course. Chronic complication was predicted by the need for surgical management and failed CRP reduction by 50% at day 4/5.
Conclusions:
CRP trends over 96 hours after the commencement of treatment differentiate patients with AHO likely to experience severe disease.
Level Of Evidence:
Level II, retrospective study.
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