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Predictors of Outcome in Pediatric Osteomyelitis: Five Years Experience in a Single Tertiary Center

Martin, Andrew C. MD; Anderson, Denise BSc; Lucey, Julie MRCPI; Guttinger, Robin FRACP; Jacoby, Peter A. MSc; Mok, Tabitha J. MB BS; Whitmore, Timothy J. MB BS; Whitewood, Colin N. FRACS; Burgner, David P. PhD; Blyth, Christopher C. FRACP

The Pediatric Infectious Disease Journal: April 2016 - Volume 35 - Issue 4 - p 387–391
doi: 10.1097/INF.0000000000001031
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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.

Supplemental Digital Content is available in the text.

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.

Accepted for publication September 30, 2015.

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

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Andrew C. Martin, MD, Department of General Paediatrics, Princess Margaret Hospital for Children, GPO Box D184, Perth, WA 6840, Australia. E-mail: andrew.martin@health.wa.gov.au.

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