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Severity Adjusted Risk of Long-term Adverse Sequelae Among Children With Osteomyelitis

Vorhies, John S., MD*; Lindsay, Eduardo A., MD; Tareen, Naureen G., MPH; Kellum, Rodney J., RN, BSN; Jo, Chan Hee, PhD; Copley, Lawson A., MD, MBA§

The Pediatric Infectious Disease Journal: January 2019 - Volume 38 - Issue 1 - p 26–31
doi: 10.1097/INF.0000000000002044
Original Studies
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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.

From the *Department of Orthopaedic Surgery, Stanford Children’s Health, Stanford, CA

Department of Orthopaedic Surgery, Children’s Health System of Texas, Dallas, TX

Department of Clinical Orthopaedic Research, Texas Scottish Rite Hospital for Children, Dallas, TX

§Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern, Dallas, TX.

Accepted for publication February 7, 2018.

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

Address for correspondence: Lawson A. B. Copley, MD, MBA, Department of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern Children’s Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235. E-mail: Lawson.copley@childrens.com.

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