Prediction of Adverse Outcomes in Pediatric Acute Hematogenous Osteomyelitis

Alhinai, Zaid; Elahi, Morvarid; Park, Sangshin; Foo, Bill; Lee, Brian; Chapin, Kimberle; Köster, Michael; Sánchez, Pablo J.; Michelow, Ian C.

doi:10.1093/cid/ciaa211

Cited by 37 publications

(88 citation statements)

References 40 publications

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“…This study was a retrospective chart review of 75 patients with documented AHO between the dates of October 1, 2015 and December 31, 2019. We found that the novel evidence-based composite scores described by Alhinai et al 5 provide means by which clinical parameters and laboratory values, available within the first couple days of diagnosis, can predict acute complicated courses and chronic morbidity.…”

Section: Discussionmentioning

confidence: 92%

“…At cut-offs of 2, 3, and 4, the ROC area was 98.6%, 93.3%, and 50.3%, respectively (Supplemental Table 2, Supplemental Digital Content 2, http://links.lww.com/ BPO/A493). At a cut-off of 3 (Youden index), 5 the C-SCORE had a sensitivity of 90.6%, a specificity of 94.4%, a PPV of 48.2%, and a NPV of 99.6% (Fig. 3).…”

Section: Predicting the Need For Antibiotics For > 12 Weeksmentioning

confidence: 98%

“…Although a severity score for adult osteomyelitis has existed since 1985,15 only recently has a severity score been proposed for pediatric AHO 5. These novel composite scores were named the A-SCORE and C-SCORE for prediction of an acute complicated course and chronic morbidity, respectively.…”

mentioning

confidence: 99%

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Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation

Vij

Singleton²,

Kang

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Pediatric acute hematogenous osteomyelitis (AHO) outcomes are highly dependent on the disease severity. Recently, the A-SCORE and C-SCORE, were proposed as predictors of an acute complicated course and chronic morbidity, respectively. The purpose of this study was to externally validate the A-SCORE and C-SCORE at a single institution. Methods: This IRB-approved retrospective chart review included AHO patients admitted at a tertiary referral hospital between October 1, 2015 and December 31, 2019. The inclusion criteria were ages 0 to 18 and clinical response to treatment. The exclusion criteria were immunocompromised status or penetrating inoculation. Results: The A-SCORE demonstrated an area under the receiver operator curve (ROC area) of > 86% with regards to all acute complications. It also demonstrated sensitivities > 85% and specificities > 92% at the cut-off of 4 (Youden index) for all acute complications. The C-SCORE demonstrated an ROC area of 100% with regards to chronic osteomyelitis. It also demonstrated sensitivities > 70% and specificities > 93% for the chronic morbidity variables seen in our population at the cut-off of 3 (Youden index.) Conclusions: These novel composite clinical scores, in combination with clinical judgment, could help guide early care decisions. The A-SCORE and C-SCORE are useful risk stratification tools in the management of pediatric AHO and in predicting acute complicated courses or chronic sequelae of AHO, respectively. These scoring systems, if integrated into standardized pediatric AHO guidelines, can allow clinicians to stratify the AHO population and guide clinical decision making. Level of Evidence: Level III (prognostic study, retrospective chart review).

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Section: Discussionmentioning

confidence: 92%

Section: Predicting the Need For Antibiotics For > 12 Weeksmentioning

confidence: 98%

See 1 more Smart Citation

Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation

Vij

Singleton²,

Kang

et al. 2022

Journal of Pediatric Orthopaedics

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“…Low PCT values have also been associated with reduced odds of ICU admission and shorter length of hospital stay compared with higher PCT concentrations in the Etiology of Pneumonia in the Community (EPIC) study, a multicenter study of 532 hospitalized children with pneumonia [24]. Recent prediction scores developed to identify complications of acute hematogenous osteomyelitis in children include biomarkers such as total leukocyte count, erythrocyte sedimentation rate (ESR) and CRP along with clinical characteristics [25,26]. The inclusion of single or serial PCT values could further strengthen these prediction scoring systems and warrants further research.…”

Section: Discussionmentioning

confidence: 99%

Prospective Observational Study to Determine Kinetics of Procalcitonin in Hospitalized Children Receiving Antibiotic Therapy for Non-Critical Acute Bacterial Infections

et al. 2020

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Introduction: The kinetics of procalcitonin in pediatric patients with non-critical acute bacterial infections receiving appropriate antibiotic therapy are not well described. Methods: We performed a single-center, prospective observational pilot study of children admitted to a tertiary care children's hospital who were receiving antibiotics for treatment of a non-critical acute bacterial infection, and we prospectively measured serial procalcitonin levels daily for 4 days during hospitalization. Results: Among the 46 children with baseline procalcitonin levels enrolled in the study, procalcitonin kinetics followed a half-life of approximately 24 h in most patients. Procalcitonin declined faster than C-reactive protein over the first 48 h of appropriate antibiotic treatment. There was variation in biomarker levels among participants with the same infection type, especially in participants with bacteremia, musculoskeletal infection and skin/soft tissue infection. Conclusion: Utility of procalcitonin as a biomarker to follow every 24-48 h in non-critically ill children receiving antibiotic therapy for bacterial infections as an objective measure of clinical improvement is promising.

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“…Most recently, an algorithm for "complicated" AHO was created by Alhinai et al in a cohort of 261 patients in the U.S 40 . Their retrospective chart review sought predictive factors for either acute complications or chronic complications.…”

Section: Predicting Severity Of Illnessmentioning

confidence: 99%

Predictive Algorithms in the Diagnosis and Management of Pediatric Hip and Periarticular Infection

Hunter

Kioa

Baker

2022

Journal of Bone and Joint Surgery

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ä Although the criteria of Kocher et al. were an important advancement in our ability to diagnose septic arthritis of the hip early, the changing microbial landscape and availability of advanced imaging have rendered it insufficient for contemporary clinical use.ä Routine use of magnetic resonance imaging and recognition of disseminated disease have prompted the development of algorithms to predict concurrent osteoarticular infection in cases of septic arthritis and osteomyelitis that were previously assumed to be "isolated."ä Recent research has attempted to stratify childhood bone and joint infection (BJI) by severity to guide treatment planning. This is valuable, as patients with multifocal disease, more virulent pathogens, and immunocompromise can have longer hospital stays and require multiple surgeries.ä The increasing prevalence of clinical prediction algorithms in childhood BJI is not completely matched by quality in methodology. Clinicians need to be wary of adopting predictive algorithms prior to robust external validation.It has been >20 years since Kocher et al. pioneered a predictive algorithm that would allow more accurate diagnosis of septic arthritis (SA) of the pediatric hip 1 . Although the evaluation of childhood bone and joint infection (BJI) has evolved substantially since then, the core problem remains: how can we develop accurate, evidence-based clinical prediction algorithms that will provide informed guidance to clinicians? Interest in this field has expanded since the first study by Kocher et al. 1 . The popularity of clinical algorithms and machine learning appears to have superseded individual clinical experience with knowledge gained from modeling large data sets 2 . Furthermore, predictive modeling has the potential for identifying an elusive diagnosis or determining the probability of poor treatment outcome 3 . However, the increasing prevalence of clinical prediction algorithms is not completely matched by quality in methodology 4 . When assessing any predictive model, clinicians should establish several points, such as whether the population the model was derived from reflects their own local population, how well the model performed in external validation, and what practical impact these predictions will have on clinical decisions 3 .Clinical prediction algorithms for childhood BJI attempt to provide guidance for 3 main clinical problems: differentiating SA from transient synovitis (TS) of the hip, predicting periarticular infection, and predicting a more severe course of illness. These areas are the focus of this review, which aims to provide an informed analysis of the diagnostic algorithms available to clinicians in assessing childhood BJI and their performance in external validation.Differentiating TS from SA of the Hip The Kocher criteria 1 , in 1999, used 4 features to raise suspicion for SA: (1) an inability to weight-bear, (2) a white blood-cell count (WBC) of >12 • 10 9 cells/L, (3) an erythrocyte sedimentation rate (ESR) of ‡40 mm/hr, and (4) a temperature of >38.5°C (>1...

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Prediction of Adverse Outcomes in Pediatric Acute Hematogenous Osteomyelitis

Cited by 37 publications

References 40 publications

Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation

Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation

Prospective Observational Study to Determine Kinetics of Procalcitonin in Hospitalized Children Receiving Antibiotic Therapy for Non-Critical Acute Bacterial Infections

Predictive Algorithms in the Diagnosis and Management of Pediatric Hip and Periarticular Infection

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