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Clinical outcomes of pediatric osteomyelitis
Kylie Disch1, Deirdre A Hill2, Harry Snow3
1The University of New Mexico School of Medicine, Albuquerque, USA.
Insights
Serious outcomes from pediatric osteomyelitis are more frequent with chronic infections than acute ones. Chronic osteomyelitis cases show higher rates of long-term orthopedic care needs and multiple surgeries.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Clinical Epidemiology
Background:
- Osteomyelitis in children can lead to severe complications.
- The frequency and types of complications based on osteomyelitis classification (acute vs. chronic) are not well-documented.
Purpose of the Study:
- To determine the frequency and distribution of severe sequelae in children diagnosed with acute or chronic osteomyelitis.
- To compare outcomes such as limb length discrepancies, pathologic fractures, mortality, and need for extensive orthopedic care between acute and chronic osteomyelitis cases.
Main Methods:
- A retrospective analysis of the HealthFacts® database (2015) was conducted.
- Included 869 pediatric patients with acute or chronic osteomyelitis identified via ICD-10 codes.
- Outcomes analyzed included limb length discrepancies, pathologic fractures, mortality, and need for prolonged orthopedic care, compared using chi-square and t-tests.
Main Results:
- Chronic osteomyelitis cases were more frequent in older children and associated with higher rates of pathologic fractures, multiple surgeries, and long-term orthopedic follow-up.
- Limb length discrepancies were rare and similarly distributed across both acute and chronic osteomyelitis.
- Mortality was low, with four deaths during hospitalization (two acute, two chronic).
Conclusions:
- While infrequent, severe outcomes from pediatric osteomyelitis are more prevalent in chronic cases compared to acute cases.
- Chronic osteomyelitis necessitates more intensive and prolonged orthopedic management.
Background:
Osteomyelitis in children may produce severe sequelae. However, the frequency and distribution of such complications by type of osteomyelitis (chronic or acute) is not well described.
Methods:
We searched the HealthFacts® database (containing medical information on 68 million individual patients in the United States) with 238 International Classification of Diseases (ICD) version 10 codes for acute osteomyelitis and chronic osteomyelitis appearing in 2015. Outcomes were recorded for each subject, including development of limb length discrepancies, pathologic fractures, mortality, and need for multiple surgeries or prolonged orthopedic care (one to two years following diagnosis). Gender, age and season of diagnosis were also assessed. Chi-square tests were used to compare differences between categorical variables, and t-tests between continuous variables.
Results:
Eight hundred sixty-nine subjects were included (57.4% male). Children with chronic osteomyelitis were older than those with acute osteomyelitis (median 9.5 years vs 12.0, respectively, p = .0004). Diagnoses were more common in winter (p = .0003). Four subjects died while hospitalized during the study period (two with acute osteomyelitis, two with chronic osteomyelitis). Limb length discrepancies were rare and similarly distributed between infection types (≤ 1.3% of subjects, p = .83). Subjects with chronic osteomyeltis were more likely to require long-term orthopedic follow-up (14.0% vs. 4.8% for acute osteomyelitis, p < .0001), suffer from pathologic fractures (1.5% vs < 1.0%, p = .003) and to require multiple surgeries (46.0% vs. 29.3%, p = .04).
Conclusions:
Though infrequent, serious outcomes from osteomyelitis are more common with chronic osteomyelitis than acute osteomyelitis.
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