Background Patients with sickle cell disease (SCD) are at increased risk for osteomyelitis (OM). Diagnosis of OM in SCD is challenging as the clinical presentation is similar to a vasoocclusive crisis (VOC) with no diagnostic gold standard. We report characteristics and outcomes of OM in SCD patients treated at our center over 10‐year period. Design/Method We conducted a retrospective analysis of patients with SCD who were treated for OM at our center over a 10‐year period (2006‐2016). Cases were identified utilizing radiology data mining software. Radiology reports and medical charts of potential OM cases were reviewed. Results Twenty‐eight children with SCD were treated for OM at our institution. Patients treated for OM were largely similar to patients treated for a VOC. However, patients treated for OM had significantly higher C‐reactive protein (10 mg/dL vs 5.58 mg/dL, P = 0.03) and erythrocyte sedimentation rate (60 mm/h vs 47 mm/h, P = 0.02). Magnetic resonance imaging (MRI) findings were consistent with OM in 18 (64%) patients and indeterminate in the remaining. Based on clinical, laboratory, and radiological findings, the diagnosis of OM was considered confirmed in 3 patients, probable in 6 patients, and presumed in 19 patients. Nontyphoidal Salmonella was isolated from cultures in 9 (32%) patients, while no organism was identified in 19 (67%) patients. All patients were treated with antibiotics. Six patients (21%) required surgical interventions. Conclusions OM continues to pose diagnostic challenges. Most patients are treated for OM without definitive confirmation. Nontyphoidal Salmonella was the only organism identified in our cohort.

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Objectives To determine whether adolescents in EDs who report engaging in high risk sexual behaviors are less likely to identify a primary care provider (PCP) and more likely to access the emergency department (ED) than their sexually inexperienced peers. Methods Secondary analysis of adolescents presenting to a pediatric ED with non-sexually transmitted infection (STI)-related complaints who completed surveys to assess sexual behavior risk and health care access. We measured differences in self-reported PCP identification, preferential use of the ED, and number of ED visits over a 12-month period by sexual experience. Secondary outcomes included clinician documented sexual histories and STI testing. Results Of 758 patients meeting inclusion criteria, 341 (44.9%) were sexually experienced and of those, 129 (37.8%) reported engaging in high risk behavior. Participants disclosing high risk behavior were less likely to identify a PCP (aOR 0.5; 95% CI 0.3, 0.9), more likely to prefer the ED for acute care issues (aOR 1.6; 95% CI 1.0, 2.6) and had a higher rate of ED visits (aRR 1.2; 95% CI 1.0,1.3) compared to sexually inexperienced peers. Among patients disclosing high risk behavior, 10.9% had clinician-documented sexual histories and 2.6% underwent STI testing. Conclusion Adolescents who reported engaging in high risk sexual behaviors were less likely to identify a PCP, and more likely to prefer ED-based care and make more ED visits. However, ED clinicians infrequently obtained sexual histories and performed STI testing in asymptomatic youth, thereby missing opportunities to screen high-risk adolescents who may lack access to preventive care.

GlycA is not a suitable biomarker of inflammation in SCD. We surmise that its signal is confounded by hemolysis leading to a depletion of haptoglobin, one of the major plasma proteins included in the composite NMR signal. Hemolysis is further exacerbated during an acute pain crisis, hence the lower GlycA levels in crisis compared to steady state.