Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation

Vij, Neeraj; Singleton, Ian M.; Kang, Paul; Esparza, Melissa; Burns, Jessica; Belthur, Mohan V.

doi:10.1097/bpo.0000000000002159

Cited by 9 publications

(12 citation statements)

References 23 publications

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“…Since then, the transition to oral antibiotics after a short course (3–5 days) of intravenous antibiotics has proven to be efficacious. CRP is a useful marker of improvement in treatment prior to even defervescence [66 ▪ ,67 ▪ ]. In 2016, Chou et al established a decrease of 50% in CRP as useful marker to timing of transition to oral antibiotics [68].…”

Section: Osteomyelitismentioning

confidence: 99%

Pediatric musculoskeletal infections

Hannon

Lyons²

2023

Current Opinion in Pediatrics

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Purpose of reviewThe aim of this article is to review the recent guidelines and literature regarding the diagnosis and the treatment of common pediatric musculoskeletal infections: septic arthritis, osteomyelitis, pyomyositis, and Lyme disease.Recent findingsIn the last decade, a better understanding of the causative organisms of common bacterial infections, including Kingella, leads to prompt targeted antimicrobial coverage in all musculoskeletal infections. Prompt diagnosis and treatment continues to be the mainstay in the treatment of children with osteoarticular infections. Efforts to improve early detection have lead to improving rapid lab diagnostic testing; however, more advanced diagnostics such as arthrocentesis for septic arthritis and MRI for osteomyelitis and pyomyositis, remain the gold standard. Shorter and narrowed antibiotic courses, with appropriate transition to outpatient oral treatment provide effective infection clearance and reduction in complications of disease.SummaryAdvances in diagnostics, including pathogen identification as well as imaging continues to improve our ability to diagnose and treat these infections, although still lack ability to provide definitive diagnosis without more invasive nor advanced techniques.

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Section: Osteomyelitismentioning

confidence: 99%

Pediatric musculoskeletal infections

Hannon

Lyons²

2023

Current Opinion in Pediatrics

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“…CRP has great utility as both a diagnostic and a monitoring agent [ 17 ]. ESR rises and drops slower than CRP levels in acute infections and is no longer considered a routine measurement for diagnosing osteomyelitis [ 18 ]. Measuring both ESR and CRP may slightly improve sensitivity and negative predictive value for diagnosis; however, further investigation is necessary to establish a certain diagnostic role in osteomyelitis [ 18 ].…”

Section: Reviewmentioning

confidence: 99%

Primary Fibular Osteomyelitis in Children: A Systematic Review

Nikkhahmanesh¹,

Vij²,

Ranade³

et al. 2023

Cureus

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Osteomyelitis of the fibula is rare and is especially rare in children. The published literature is limited to case series and is thus lacking a comprehensive description of the disease. The purpose of this systematic review is to provide the first comprehensive summary of the demographics, presenting symptoms, laboratory values, microbiology, and treatment results of osteomyelitis of the fibula in children based on the existing literature. This institutional review board (IRB)-exempt systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. Three search engines were used for a total of 239 studies. Twenty-six studies were screened by full text. Twelve articles underwent a quantitative analysis. Due to limited data and heterogenous reporting, the data were summarized descriptively. The methodologic quality of the studies was evaluated based on the Newcastle-Ottawa scale. The average age was 7.71±3.49 years, and males comprised 57% of the 21 cases. The most common presenting symptoms were fever (86%), antalgic gait (57%), and localized tenderness (81%). The most common site of involvement was the distal third of the fibula (90%). The average C-reactive protein (CRP) was 90.1±38.3 mg/L, and the average erythrocyte sedimentation rate (ESR) was 58.8±21.2 mm/hour. Staphylococcus aureus was the most cultured pathogen reported in 10/21 cases (48%). Open surgery was performed in 17/21 cases (81%), and there were no reported complications. Fever, antalgic gait, and localized tenderness should raise the index of suspicion. Prompt laboratory and radiographic evaluations can help reduce delays in diagnosis and improve outcomes. Blood and tissue cultures are currently performed in about half of the cases. Improvement in our microbiologic diagnosis has the potential to improve antibiotic selection. Local methicillin-resistant Staphylococcus aureus (MRSA) prevalence must be taken into consideration when starting empiric antibiotic treatment. Surgical treatment is often required with a low complication rate. The clinical and laboratory parameters identified in this study have the potential for integration into a composite clinical score.

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“…Another focus is the prediction of a complex course during the management of osteomyelitis and, ideally, strategies to avoid that. The A-SCORE (acute) has been validated as a predictor of a complex course and the C-SCORE (chronic) has been validated as a predictor of chronic morbidity for acute or chronic osteomyelitis 67 . Osteoarticular infections with methicillin-resistant Staphylococcus aureus were found to increase the odds of needing multiple operative debridements by 4.6-fold 68 .…”

Section: Infectionmentioning

confidence: 99%

What’s New in Pediatric Orthopaedics

Andras

Sanders²,

Goldstein

et al. 2022

Journal of Bone and Joint Surgery

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This pediatric orthopaedic update represents a review of articles predominantly from October 2021 to October 2022. Spine Adolescent Idiopathic ScoliosisAs we strive toward optimal adolescent idiopathic scoliosis treatment that will serve patients well into adulthood, longterm follow-up studies are of particular importance. Lander et al. reported on a series of 134 patients treated with Harrington instrumentation with a minimum 40-year follow-up. Patients with a lowest instrumented vertebra (LIV) at L3 or proximal had a lower likelihood of undergoing additional surgical procedures at 13% compared with patients with an LIV at L4 or distal at 36%, but, aside from this, the groups were similar with regard to health-related quality of life and their scores were not different from normal age-based means 11 . Also encouraging was the report on 115 patients with a 25year follow-up that showed that the serum levels of cobalt and chromium ions were similar in the patients treated with Harrington instrumentation compared with a control group of patients treated with bracing 12 . However, questions with regard to the long-term effect of retained implants continue to generate concern as titanium levels were found to be persistently elevated to 5 times the preoperative level at the 2-year follow-up in a series with more contemporary implants 13 . The impact of this remains unknown but warrants continued study.There remains continued interest in leveraging technology to achieve optimal pedicle screw placement safely and consistently. In a systematic review and meta-analysis by Baldwin et al., screws placed with intraoperative computed tomographic (CT) navigation were determined to be one-third Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H355).

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Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation

Cited by 9 publications

References 23 publications

Pediatric musculoskeletal infections

Pediatric musculoskeletal infections

Primary Fibular Osteomyelitis in Children: A Systematic Review

What’s New in Pediatric Orthopaedics

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