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Acute haematogenous osteomyelitis in children in Finland. Finnish Study Group
L Unkila-Kallio1, M J Kallio, H Peltola
1Children's Hospital, University of Helsinki, Finland.
Insights
Acute haematogenous osteomyelitis (AHOM) in children is often caused by Staphylococcus aureus. Early diagnosis and treatment in Finland lead to good outcomes, with long bones being the most common sites affected.
Area of Science:
- Pediatric infectious diseases
- Orthopedic surgery
- Microbiology
Background:
- Acute haematogenous osteomyelitis (AHOM) is a serious bone infection in children.
- Early diagnosis and prompt treatment are crucial for favorable outcomes.
Purpose of the Study:
- To analyze the clinical presentation, diagnostic challenges, and outcomes of AHOM in Finnish children.
- To identify the primary causative agents and affected bone sites.
Main Methods:
- Prospective study of 47 children under 15 with bacteriologically confirmed AHOM in Finland (1981-1993).
- Data collected on patient history, clinical signs, laboratory values (CRP, ESR), imaging, and treatment timelines.
- Causative pathogen identification and affected bone site analysis.
Main Results:
- Staphylococcus aureus was the predominant pathogen (89%).
- Tibia and femur were most frequently affected, with pelvis and calcaneus more common in children over 4.
- Most children presented with classic symptoms and elevated inflammatory markers, but negative X-rays.
- 19% experienced delayed hospital admission, and 11% had delayed antimicrobial therapy (>48 hours).
- All patients showed good recovery at 1-year follow-up.
Conclusions:
- Children in Finland generally receive early treatment for AHOM, contributing to good outcomes.
- Staphylococcus aureus is the main cause, primarily affecting long bones, but also pelvis and calcaneus in older children.
- No significant delays in admission or diagnosis impacted patient outcomes negatively.
Abstract:
The purpose of the study was to evaluate the history, clinical picture and diagnostic difficulties of acute haematogenous osteomyelitis (AHOM) in children. Forty-seven children under the age of 15 with bacteriologically proven AHOM were collected prospectively in Finland in 1981-93. Staphylococcus aureus was responsible for 89% of the cases. The commonest sites affected were the tibia (25%) and the femur (23%) followed by the pelvis (15%) and the calcaneus (11%). Sites other than the long bones increased in frequency in children over the age of 4 years. Most of the children came with a history of a week or less with classic signs and symptoms of AHOM, increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values but negative X-rays. Delay in hospital admission was observed in 19%. In 11% antimicrobial therapy was not instituted within 48 hours on ward. All children were clinically healthy at the 1-year check-up with minor X-ray changes seen in 11 patients. We conclude that children in Finland seek treatment early in the course of AHOM and have a good outcome. S. aureus is the main aetiological agent affecting primarily the long bones, but in older children pelvic and calcaneic sites are also frequent. No significant delays affecting the outcome were noticed in admittance to hospital or in the diagnosis of AHOM.