Andrew C Martin1, Denise Anderson, Julie Lucey, Robin Guttinger, Peter A Jacoby, Tabitha J Mok, Timothy J Whitmore, Colin N Whitewood, David P Burgner, Christopher C Blyth. 1. From the *Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Australia; †School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia, ‡Telethon Kids Institute, Perth, Australia; §Department of Orthopaedic Surgery, Princess Margaret Hospital for Children, Perth, Australia; ¶Murdoch Childrens Research Institute, Parkville, Australia; ‖Department of Paediatrics, University of Melbourne, Parkville, Australia; **Department of Paediatrics, Monash University, Clayton, Australia; ††PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, Perth, Australia; and ‡‡Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia.
Abstract
BACKGROUND: Acute haematogenous osteomyelitis is a bacterial infection of bone, which occurs most frequently in children. Outcomes are excellent for the majority of children, but a minority develop complicated osteomyelitis. Predicting which children will develop complicated osteomyelitis remains a challenge, particularly in developed countries where most patients are discharged home after a relatively short period in hospital. METHODS: We conducted a 5-year retrospective case note review of all children aged 3 months to 16 years admitted with a diagnosis of acute haematogenous osteomyelitis. We compared standardized clinical and laboratory parameters in those who developed simple and complicated osteomyelitis. RESULTS: Of the 299 children who met inclusion, 241 (80.6%) had simple and 58 (19.4%) had complicated osteomyelitis. The major predictors of complicated disease were older age, a temperature greater than 38.5°C and a higher C-reactive protein at admission. CONCLUSIONS: A risk prediction model, utilizing information available shortly after hospitalization, allows early identification of children at greatest risk of developing complicated osteomyelitis.
BACKGROUND:Acute haematogenous osteomyelitis is a bacterial infection of bone, which occurs most frequently in children. Outcomes are excellent for the majority of children, but a minority develop complicated osteomyelitis. Predicting which children will develop complicated osteomyelitis remains a challenge, particularly in developed countries where most patients are discharged home after a relatively short period in hospital. METHODS: We conducted a 5-year retrospective case note review of all children aged 3 months to 16 years admitted with a diagnosis of acute haematogenous osteomyelitis. We compared standardized clinical and laboratory parameters in those who developed simple and complicated osteomyelitis. RESULTS: Of the 299 children who met inclusion, 241 (80.6%) had simple and 58 (19.4%) had complicated osteomyelitis. The major predictors of complicated disease were older age, a temperature greater than 38.5°C and a higher C-reactive protein at admission. CONCLUSIONS: A risk prediction model, utilizing information available shortly after hospitalization, allows early identification of children at greatest risk of developing complicated osteomyelitis.
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