John S Vorhies1, Eduardo A Lindsay2, Naureen G Tareen2, Rodney J Kellum2, Chan Hee Jo3, Lawson A Copley4. 1. From the Department of Orthopaedic Surgery, Stanford Children's Health, Stanford, CA. 2. Department of Orthopaedic Surgery, Children's Health System of Texas, Dallas, TX. 3. Department of Clinical Orthopaedic Research, Texas Scottish Rite Hospital for Children, Dallas, TX. 4. Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern, Dallas, TX.
Abstract
BACKGROUND: The purpose of this investigation was to evaluate the risk for long-term, adverse outcomes among children with osteomyelitis. METHODS: Children with osteomyelitis were prospectively enrolled from 2012 to 2014. Care was accomplished by a multidisciplinary team according to an institutional algorithm. Data were collected to define the severity of illness during the initial hospitalization and assess short, intermediate and long-term outcomes. Clinical examination, radiographic assessment and functional outcome survey administration were performed at a minimum of 2 year follow-up. A comparison cohort analysis was performed according to initial severity of illness score of mild (0-2), moderate (3-6) and severe (7-10). RESULTS: Of 195 children enrolled, 139 (71.3%) returned for follow-up at an average of 2.4 years (range, 2.0-5.0 years). Children with severe illness were less likely to have normal radiographs (severe, 4.0%; moderate, 38.2%; mild, 53.2%, P < 0.0001), and more likely to have osteonecrosis, chondrolysis, or deformity (severe, 32.0%; moderate, 5.9%; mild, 1.3%, P < 0.0001). Functional outcome measures did not significantly differ between severity categories. By regression analysis severity of illness score, plus age less than 3 years and Methicillin-resistant Staphylococcus aureus predicted severe sequelae with an area under the curve of 0.8617 and an increasing odds ratio of 1.34 per point of increase in severity score. CONCLUSION: Long-term severe adverse outcomes among children with osteomyelitis occurred in 11 of 139 (7.9%) children and were predicted by initial severity of illness. Other risks that diminished the likelihood of complete resolution or increased the risk of severe sequelae included Methicillin-resistant Staphylcoccus aureus etiology and young age. The majority of children with osteomyelitis do not require long-term follow-up beyond the initial treatment period.
BACKGROUND: The purpose of this investigation was to evaluate the risk for long-term, adverse outcomes among children with osteomyelitis. METHODS:Children with osteomyelitis were prospectively enrolled from 2012 to 2014. Care was accomplished by a multidisciplinary team according to an institutional algorithm. Data were collected to define the severity of illness during the initial hospitalization and assess short, intermediate and long-term outcomes. Clinical examination, radiographic assessment and functional outcome survey administration were performed at a minimum of 2 year follow-up. A comparison cohort analysis was performed according to initial severity of illness score of mild (0-2), moderate (3-6) and severe (7-10). RESULTS: Of 195 children enrolled, 139 (71.3%) returned for follow-up at an average of 2.4 years (range, 2.0-5.0 years). Children with severe illness were less likely to have normal radiographs (severe, 4.0%; moderate, 38.2%; mild, 53.2%, P < 0.0001), and more likely to have osteonecrosis, chondrolysis, or deformity (severe, 32.0%; moderate, 5.9%; mild, 1.3%, P < 0.0001). Functional outcome measures did not significantly differ between severity categories. By regression analysis severity of illness score, plus age less than 3 years and Methicillin-resistant Staphylococcus aureus predicted severe sequelae with an area under the curve of 0.8617 and an increasing odds ratio of 1.34 per point of increase in severity score. CONCLUSION: Long-term severe adverse outcomes among children with osteomyelitis occurred in 11 of 139 (7.9%) children and were predicted by initial severity of illness. Other risks that diminished the likelihood of complete resolution or increased the risk of severe sequelae included Methicillin-resistant Staphylcoccus aureus etiology and young age. The majority of children with osteomyelitis do not require long-term follow-up beyond the initial treatment period.
Authors: Thomas K Fehring; Keith A Fehring; Angela Hewlett; Carlos A Higuera; Jesse E Otero; Aaron J Tande Journal: J Bone Joint Surg Am Date: 2020-07-15 Impact factor: 6.558
Authors: Andrzej Krzysztofiak; Marco Roversi; Antonio Musolino; Marco Cirillo; Renato Maria Toniolo; Osvaldo Mazza; Livia Gargiullo; Laura Lancella; Paolo Rossi; Alberto Villani Journal: Sci Rep Date: 2022-09-01 Impact factor: 4.996