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Presentation and Investigation of Pediatric Bone and Joint Infections in the Pediatric Emergency Department

Akinkugbe, Olugbenga MBBS, MA, MRCPCH; Stewart, Charles MBBCH, BSc, MRCPCH, DipSEM; McKenna, Caoimhe MBBS

doi: 10.1097/PEC.0000000000001431
Original Articles
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Objective The objective of this study was to evaluate the presenting features of bone and joint infections with a view to identify distinguishing trends that will be useful for pediatric emergency departments.

Methods We performed a retrospective review of patient records over a 12-year period in the pediatric emergency department of a large regional pediatric teaching center serving a diverse population.

Results There were 88 cases of osteoarticular infections during the study period. Pain, fever, and impaired function were commonly reported, but overall, there was inconsistency in the presenting features. Inflammatory makers were sensitive tools, particularly in combination. When C-reactive protein, total white cell count, and erythrocyte sedimentation rate were all abnormal, 98% of bone and joint infections were identified.

Causative organisms were identified in only 38% of cases, mostly from cultures of synovial fluid and bone. Streptococcal organisms were significantly more likely to be isolated in children under 5 years than in children over 5 years (P = <0.014). Staphylococcal organisms were significantly more likely to be isolated in children over 5 years than in children under 5 years (P = <0.001). Identification of virulent organisms such as Panton-Valentine leukocidin Staphylococcus aureus and methicillin-resistant S. aureus in our study should prompt review of diagnostic techniques and antibiotic choices.

Conclusions Overall, children under 5 years were significantly more likely to be diagnosed with septic arthritis than osteomyelitis (P = 0. 006). Children over 12 years were significantly more likely to be diagnosed with osteomyelitis than septic arthritis (P = 0. 019). These trends are useful to consider at presentation and in cases of diagnostic uncertainty.

From the Department of Pediatric Emergency Medicine, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom.

Disclosure: The authors declare no conflict of interest.

Collaborator: Dr Alan J. Poots, MA(Oxon) MSc, PhD, FLS, Principal Information Analyst, Imperial College, London, United Kingdom.

Reprints: Olugbenga Akinkugbe, MBBS, MA, MRCPCH, Pediatrics Department, Pediatric Emergency Medicine, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Rd, London, SW10 9NH, United Kingdom (e-mail: o.akinkugbe@nhs.net).

Online date: March 6, 2018

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