Review article: How useful are laboratory investigations in the Emergency Department evaluation of possible osteomyelitis?

Abstract

We conducted a literature review to determine which laboratory investigations are useful for the ED evaluation of osteomyelitis. Thirty-six relevant papers were identified. We concluded that in adult and paediatric patients with a clinically low level of suspicion of osteomyelitis, an age-adjusted normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) <5 mg/L should reassure the clinician that no further urgent investigation is required. For patients with risk factors for osteomyelitis or a clinically high level of suspicion, a normal ESR or CRP <5 mg/L should not rule out the diagnosis of osteomyelitis, especially in patients with puncture wounds or foot ulcers/infections. In patients with any suspicion of osteomyelitis and otherwise unexplained ESR >30 mm/h and/or CRP >10-30 mg/L further definitive investigation is required. The white blood count is not helpful in the evaluation of osteomyelitis.

Acute haematogenous osteomyelitis in children

“…2 The onset of osteomyelitis can be insidious, the clinical presentation variable, and the physical findings non-specific. 22 No single test can confirm or rule out acute osteomyelitis. A combination of careful history and examination, accompanied by a high index of clinical suspicion, and followed by laboratory and imaging studies are key parts of the clinical investigations.…”

“…It has been investigated in the critical care setting as a possible differentiator between bacterial, viral, and inflammatory processes. 22 A prospective study of 44 children found that increased levels differentiated osteomyelitis and septic arthritis from other diseases (for example, arthritis, soft tissue infection, trauma) more effectively than C reactive protein, erythrocyte sedimentation rate, or white cell count. 45…”

Characteristics and outcomes of osteomyelitis in children with sickle cell disease: A 10‐year single‐center experience

“…5 ESR and CRP are commonly utilized in the clinical setting to support the diagnosis of OM in children and for evaluating the response to therapy. 10,11 Data on their utility for diagnosis of OM in children with SCD are limited. 9,12,13 Of note, we found that patients who were Note: Other includes scapula, clavicle, hand, rib, and mandible sites of involvement infarction.…”

A 57-year-old Man With a History of Prostatectomy and Pelvic Irradiation Presents With Recurrent Urinary Tract Infections, Hematuria, and Pelvic Pain

“…Additionally, high levels of C-reactive protein—100 mg/L—can be a sensitive, but not a specific, indicator of osteomyelitis. 1 This concern, coupled with the possibility of an upper tract source of his hematuria, prompted axial computed tomography (CT) of the abdomen and pelvis with intravenous contrast and delayed imaging. The CT scan revealed normal ureters and kidneys but demonstrated sclerosis of the sacrum, diastasis of the pubic symphysis, and fractures of the bilateral superior and inferior pubic rami.…”