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A Proposed Scoring System for Assessment of Severity of Illness in Pediatric Acute Hematogenous Osteomyelitis Using Objective Clinical and Laboratory Findings

Copley, Lawson A. B. MD*; Barton, Theresa MD; Garcia, Carla MD; Sun, David MD§; Gaviria-Agudelo, Claudia MD; Gheen, William T. BA; Browne, Richard H. PhD

The Pediatric Infectious Disease Journal: January 2014 - Volume 33 - Issue 1 - p 35–41
doi: 10.1097/INF.0000000000000002
Original Studies

Background: Severity of illness in children with acute hematogenous osteomyelitis (AHO) is variable, ranging from mild, requiring short-duration antibiotic therapy without surgery, to severe, requiring intensive care, multiple surgeries and prolonged hospitalization. This study evaluates severity of illness among children with AHO using clinical and laboratory findings.

Methods: Fifty-six children with AHO, consecutively treated in 2009, were retrospectively studied. Objective clinical, radiographic and laboratory parameters related to severity of illness were gathered for each child. A physician panel was assembled to rank order objective clinical parameters, review clinical data and classify each child as mild, moderate or severe. Statistically significant parameters correlated with length of hospitalization were utilized to devise a severity of illness score and applied to the cohort of children for internal validation.

Results: The physician panel had perfect or substantial agreement regarding 7 parameters (ICU admission, intubation, pulmonary involvement, venous thrombosis, multifocal infection, surgeries and febrile days on antibiotics). Parameters that significantly correlated with total length of stay included: C-reactive protein values at admission (P < 0.0001), 48 hours (P < 0.0001) and 96 hours (P < 0.0002); febrile days on antibiotics (P < 0.0001); admission respiratory rate (P = 0.023) and evidence of disseminated disease (P = 0.016). A scoring system, derived from selected parameters, significantly differentiated children with AHO on the basis of causative organism, intensive care admission, surgeries, length of hospitalization, complications and physician panel assessment.

Conclusions: Severity of illness score for AHO, derived from preliminary clinical and laboratory findings, is useful stratifying children with this disease. Level of Evidence: Prognostic Level II

From the *Orthopedic Surgery, University of Texas Southwestern; Pediatric Infectious Disease, University of Texas Southwestern; General Pediatrics, Children’s Medical Center of Dallas; §Department of Orthopedic Surgery, Baylor College of Medicine; Orthopedics, Children’s Medical Center of Dallas; and Texas Scottish Rite Hospital for Children, Dallas, TX.

Accepted for publication August 7, 2013.

The authors have no funding or conflicts of interest or funding to disclose

Address for correspondence: Lawson A. B. Copley, MD, Associate Professor of Orthopedic Surgery, University of Texas Southwestern, Children’s Medical Center of Dallas, 1935 Medical District Drive, Dallas, TX 75235. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.