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Does rickets carry an increased risk of osteomyelitis and septic arthritis? An aggregated electronic health record
Monish S Lavu1, Chloe Van Dorn1, Lukas Bobak1
1Department of Orthopaedics, Case Western Reserve University School of Medicine.
Insights
Pediatric patients with rickets have significantly higher risks of osteomyelitis and septic arthritis. This study highlights the need for increased clinical vigilance for these serious musculoskeletal infections in children with rickets.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Rheumatology
Background:
- Rickets, a condition characterized by bone softening, can have various underlying causes and potential complications.
- Musculoskeletal infections, such as osteomyelitis and septic arthritis, are serious conditions in children that require prompt diagnosis and treatment.
Purpose of the Study:
- To determine the prevalence of osteomyelitis and septic arthritis in pediatric patients diagnosed with rickets.
- To compare the risk of these infections in children with rickets versus the general pediatric population.
Main Methods:
- A retrospective cohort study utilizing the TriNetX analytics network, comprising deidentified electronic health records of over 105 million US patients.
- Pediatric patients (≤18 years) with rickets diagnoses (ICD-10-CM codes) were identified, along with a control cohort without rickets.
- Prevalence and relative risks of osteomyelitis and septic arthritis diagnoses were calculated for both cohorts.
Main Results:
- Among 7,337 pediatric patients with rickets, 1.31% had osteomyelitis and 0.38% had septic arthritis.
- In comparison, among 17,240,604 pediatric patients without rickets, 0.10% had osteomyelitis and 0.05% had septic arthritis.
- Pediatric patients with rickets showed a 13.27-fold increased relative risk for osteomyelitis and a 7.72-fold increased relative risk for septic arthritis.
Conclusions:
- Pediatric patients with rickets have substantially higher relative risks for developing osteomyelitis and septic arthritis compared to their peers without rickets.
- These findings underscore the critical importance of heightened clinical awareness and vigilance for musculoskeletal infections in children diagnosed with rickets.
- This study is the first to investigate the association between rickets and these specific bone and joint infections in a large pediatric cohort.
Abstract:
To investigate the prevalence of osteomyelitis and septic arthritis in pediatric patients with rickets, compared to the general population. A retrospective cohort study was conducted using the TriNetX analytics network, which aggregates deidentified electronic health record data from over 105 million US patients. We queried pediatric patients with rickets, based on ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) encounter diagnoses. Patients with any ICD-10-CM encounter diagnoses of osteomyelitis or septic arthritis were reported. We established a control cohort of pediatric patients without rickets. Of 7337 pediatric patients (≤18 years old) with a rickets diagnosis, 96 [1.31%, 95% confidence interval (CI): 1.05%-1.57%] had a diagnosis of osteomyelitis and 28 (0.38%, 95% CI: 0.24%-0.52%) had a diagnosis of septic arthritis. In comparison, of the 17 240 604 pediatric patients without a rickets diagnosis, 16 995 (0.10%, 95% CI: 0.10%-0.10%) had a diagnosis of osteomyelitis and 8521 (0.05%, 95% CI: 0.05%-0.05%) had a diagnosis of septic arthritis. The relative risk for an osteomyelitis diagnosis in pediatric patients with a rickets diagnosis was 13.27 (95% CI: 10.86-16.23), while the relative risk for a septic arthritis diagnosis was 7.72 (95% CI: 5.33-11.18). Pediatric patients with a diagnosis of rickets have over 10- and 5-times higher relative risks for having a diagnosis of osteomyelitis and septic arthritis, respectively, compared to those without a diagnosis of rickets. This is the first study to explore musculoskeletal infections in rickets patients, highlighting the importance of clinicians being vigilant about these conditions.
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