Hematogenous Osteomyelitis
It can be difficult to diagnose in pediatric patients due to the condition's often vague presentation - Hasan S Merali
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Acute Hematogenous Osteomyelitis in Children
“The X-ray was normal, so I did not pursue a diagnosis of osteomyelitis.”
X-rays are often normal in AHO, and non-specific changes are seen in only 15% to 58% of patients with AHO. X-rays have even less sensitivity in pelvic osteomyelitis. It typically takes ≥7 days for changes associated with osteomyelitis to be seen on X-ray.
“The WBC count and differential were unremarkable, so it couldn't have been osteomyelitis.”
WBC count is the least helpful of the inflammatory markers, with a sensitivity of 34% to 43% in AHO. ESR and CRP are most useful and are elevated in 73% to 100% and 70% to 100% of patients, respectively.
“I…
Resources
Osteomyelitis in Kids
Osteomyelitis can affect any bone, and as such, has a variety of presentations. Fever. Inability to walk / limping or bear weight on that extremity
An Unusual Cause of Limp in a Toddler
An 11-month-old girl presented to the pediatric emergency department (ED) with a 1-day history of refusal to bear weight on the right lower extremity. In the 2 weeks prior, her parents had noted their previously agile walker to be crawling more often. This progressed to a limp and, finally, absolute refusal to bear weight. There was no history of trauma or fever. The primary care physician had initially suspected toxic synovitis and recommended supportive care.
Antibiotic Management of Pediatric Osteomyelitis
Several points uncertainty exist regarding the antimicrobial management of acute hematogenous osteomyelitis, total duration of therapy and the use of oral stepdown to oral therapy following a period of parenteral therapy. Evidence-based approaches are not available given the lack of large prospective randomized trials addressing treatment duration or oral stepdown therapy.
Children with Acute Hematogenous Osteomyelitis Have Similar Outcomes When Discharged with Oral Antibiotics versus Prolonged IV Antibiotics and Escape PICC Complications
Previously healthy children hospitalized with a single focus of AHOM have similarly low rates of treatment failure whether discharged on oral- or PICC-administered antibiotics. Patients discharged with PICC-administered antibiotics suffer from a higher rate of return ED visit or readmission due to PICC-related complications.
Emergency Department Management Of Acute Hematogenous Osteomyelitis In Children
Acute hematogenous osteomyelitis has an annual incidence of approximately 2 to 13 cases per 100,000 persons in developed countries. It can be difficult to diagnose in pediatric patients due to the condition’s often vague presentation.
Emergency Department Management of Pediatric Septic Arthritis and Osteomyelitis
Septic arthritis and osteomyelitis in pediatric patients represent true emergencies, and can quickly threaten life and limb. A high index of suspicion should be maintained, as these conditions often present with a subacute course of illness and vague signs and symptoms. Septic arthritis and osteomyelitis can occur concurrently, so suspicion for one should also prompt investigation for the other.
Lightning Learning: Osteomyelitis in Kids
Whilst typically spread via the blood, it can also complicate cellulitis or septic arthritis and even follow on from trauma. Staphylococcus aureus is the most common bacteria implicated. Flucloxacillin is, therefore, a typical antibiotic choice. Note: other organisms are possible depending on age (e.g. neonates → Streptococcus) and background (e.g. sickle cell → Salmonella).
Peds EM Follow Up 2015: Pediatric Osteomyelitis
Functional limitations, i.e. unwilling to crawl or walk. Time course: usually several days to >1 week
Acute Hematogenous Osteomyelitis in Children
Treatment failure is common in osteomyelitis, occurring in 4.7% of children in one study. Even in the absence of sequestra or abscess, appropriate treatment can fail for reasons that are poorly understood.
Starship
This guideline covers the diagnosis and management of acute septic arthritis and acute haematogenous osteomyelitis in infants and children.
NORD
Among children and teens, the long bones of the legs and arms are most frequently affected. In adults, osteomyelitis most often affects the vertebrae of the spine and/or the hips.
Ortho Bullets
Osteomyelitis in the pediatric population is most often the result of hematogenous seeding of bacteria to the metaphyseal region of bone. Diagnosis is generally made with MRI studies to evaluate for bone marrow edema or subperiosteal abscess.
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