Deep venous thrombosis in children with musculoskeletal infections: the clinical evidence

Mantadakis, Elpis; Plessa, Eleni; Vouloumanou, Evridiki K.; Michailidis, Lambros; Chatzimichael, Athanassios; Falagas, Matthew E.

doi:10.1016/j.ijid.2011.12.012

Cited by 46 publications

(23 citation statements)

References 39 publications

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“…Patients with disseminated infection are at higher risk for systemic diseases such as sepsis, thromboembolism, and coagulopathy 18–21 . Identifying and treating these potential complications earlier could improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Prediction Algorithm to Stratify Pediatric Musculoskeletal Infection by Severity

Benvenuti

Mignemi³

et al. 2019

Journal of Pediatric Orthopaedics

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Objective There are currently no algorithms for early stratification of pediatric musculoskeletal infection (MSKI) severity that are applicable to all types of tissue involvement. In this study, the authors sought to develop a clinical prediction algorithm that accurately stratifies infection severity based on clinical and laboratory data at presentation to the emergency department. Methods An IRB-approved retrospective review was conducted to identify patients aged 0–18 who presented to the pediatric emergency department at a tertiary care children’s hospital with concern for acute MSKI over a five-year period (2008–2013). Qualifying records were reviewed to obtain clinical and laboratory data and to classify in-hospital outcomes using a three-tiered severity stratification system. Ordinal regression was used to estimate risk for each outcome. Candidate predictors included age, temperature, respiratory rate, heart rate, C-reactive protein, and peripheral white blood cell count. We fit fully specified (all predictors) and reduced models (retaining predictors with a p-value ≤ 0.2). Discriminatory power of the models was assessed using the concordance (c)-index. Results Of the 273 identified children, 191 (70%) met inclusion criteria. Median age was 5.8 years. Outcomes included 47 (25%) children with inflammation only, 41 (21%) with local infection, and 103 (54%) with disseminated infection. Both the full and reduced models accurately demonstrated excellent performance (full model c-index 0.83, 95% CI [0.79–0.88]; reduced model 0.83, 95% CI [0.78–0.87]). Model fit was also similar, indicating preference for the reduced model. Variables in this model included C-reactive protein, pulse, temperature, and an interaction term for pulse and temperature. The odds of a more severe outcome increased by 30% for every 10-unit increase in C-reactive protein. Conclusions Clinical and laboratory data obtained in the emergency department may be used to accurately differentiate pediatric MSKI severity. The predictive algorithm in this study stratifies pediatric MSKI severity at presentation irrespective of tissue involvement and anatomic diagnosis. Prospective studies are needed to validate model performance and clinical utility.

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Section: Discussionmentioning

confidence: 99%

A Clinical Prediction Algorithm to Stratify Pediatric Musculoskeletal Infection by Severity

Benvenuti

Mignemi³

et al. 2019

Journal of Pediatric Orthopaedics

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“…DVT with acute OM has been associated with MRSA (506, 508), PVL-positive strains of S. aureus (510), and USA300 in particular (507). Compared to patients with acute OM but no DVT, those with DVT were consistently unwell, likely to be bacteremic, and likely to have pulmonary involvement (presumably due to septic pulmonary emboli), and MRSA was overrepresented (511,512). Thus, a high index of suspicion for DVT is required for children with acute OM who are critically unwell or who have pulmonary involvement, and Doppler ultrasound screening near the site of infection should be considered (511).…”

Section: Osteoarticular Infections In Childrenmentioning

confidence: 99%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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SUMMARY Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.

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“…Eine Antikoagulation kann in komplexen Fällen mit tiefen Venenthrombosen und oder septischen Pulmonalembolien nötig werden. Dies sind charakteristische Komplikationen einer MRSA-OM [37]. Eine Gipsruhigstellung kann sowohl schmerzlindernd wirken als auch pathologischen Frakturen vorbeugen.…”

Section: Additive Therapieunclassified

Akute hämatogene Osteomyelitis im Wachstumsalter

et al. 2017

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Deep venous thrombosis in children with musculoskeletal infections: the clinical evidence

Cited by 46 publications

References 39 publications

A Clinical Prediction Algorithm to Stratify Pediatric Musculoskeletal Infection by Severity

A Clinical Prediction Algorithm to Stratify Pediatric Musculoskeletal Infection by Severity

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

Akute hämatogene Osteomyelitis im Wachstumsalter

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