Diagnostic Performance of Pyogenic Vertebral Osteomyelitis

Abstract

Objective Early diagnosis of pyogenic vertebral osteomyelitis (PVO) is frequently difficult. There are, however, few studies that have investigated the diagnostic performance of PVO in Japan. Our aim was to analyze the diagnostic performance and identify clinical factors associated with the diagnostic delay of PVO. Materials and Methods We performed hospital-based retrospective case analysis. All patients with PVO were identified from the computerized medical database at Okinawa Chubu Hospital in Okinawa, Japan, from January 1985 to December 2004. We collected the following data; baseline information; laboratory tests; clinical and microbiologic outcomes; and diagnostic process. We used multivariable-adjusted linear regression to identify significant factors associated with patient and hospital delay to the diagnosis of PVO. Results We reviewed total of 209,428 patients hospitalized during the 20-year study period. Of those, we identified 51 patients with PVO. Eighty percent of these patients were misdiagnosed at their initial clinical encounters. Median duration from the symptom onset to the diagnosis was 19 days. Median durations of patient factor and hospital factor that contributed to the total delay were 1 and 8 days, respectively. Significant patient factor that contributed to delay was cognitive dysfunction. Conclusions Cognitive dysfunction is a risk factor for patient delay for visiting physicians in patients with PVO. Diagnosis of PVO is difficult at the initial clinical encounter. High index of suspicion is needed for more rapid diagnosis of PVO.

Spinal infections in older people: an analysis of demographics, presenting features, microbiology and outcomes

“…9,10 Spinal infections are relatively uncommon, with incidence approximating 0.2-3.7/100 000 for spondylodiscitis and 2-20/100 000 hospital admissions for spinal epidural abscesses. 8,9,21 Relatively few spinal infection studies specifically deal with older populations. 1,10,11,[13][14][15] Delayed or missed diagnosis results in poorer outcomes, including significant morbidity, mortality and functional impairment.…”

“…Clinical assessment may be difficult because of pre-existing cognitive impairment or intercurrent delirium, as well as atypical or subtler signs, symptoms and biochemical marker abnormalities. 8,9,21 Relatively few spinal infection studies specifically deal with older populations. 8,20,22,23 Data on spinal infections in Australasia are similarly sparse.…”

Missed Opportunities for Diagnosing Vertebral Osteomyelitis Caused by Influential Cognitive Biases

“…The clinical diagnosis of vertebral osteomyelitis is challenging; a long duration from the onset of symptoms to admission (average, 48±40 days) and very high incidence of initial misdiagnosis (80%) have been reported [ 7 ]. The lack of specific symptoms and low sensitivity of diagnostic tests seem to be associated with these diagnostic delays and misdiagnoses.…”

“…Despite suspicion that vertebral osteomyelitis was improbable in this case since vertebral osteomyelitis following osteoporotic vertebral fracture is reported to be very rare [ 19 ], physicians should consider that a working diagnosis of UTI may be an indicator to continue diagnostic workup. A previous study reported that UTI was the most common initial misdiagnosis in patients with vertebral osteomyelitis [ 7 ]. Pyuria, despite being considered evidence of UTI, is not always an accurate diagnostic marker for it.…”

Investigations of Hospitalized Cases of Pyogenic Vertebral Osteomyelitis

“…There is often a considerable delay between the onset of symptoms and diagnosis (a range of 42 to 59 days in five studies) [7][8][9][10] . The reported median of the total duration to the diagnosis was 19 days 6) . In one study, the initial misdiagnosis rate was 34% with an average delayed diagnosis time of 2.6 months 11) .…”