Severity Adjusted Risk of Long-term Adverse Sequelae Among Children With Osteomyelitis

Vorhies, John S.; Lindsay, Eduardo A.; Tareen, Naureen; Kellum, Rodney J.; Jo, Chan Hee; Copley, Lawson A.

doi:10.1097/inf.0000000000002044

Cited by 18 publications

(28 citation statements)

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“…Risk for subjective or objective sequelae did not depend on the pathogen that had caused OM or SA. However, numbers are too small to draw any firm conclusions, and in only one of our patients was infection caused by MRSA, an organism previously shown to be a risk factor for severe sequelae (6,7).…”

Section: Discussionmentioning

confidence: 73%

“…Both subjective and objective sequelae were more frequently described in female participants. This was not observed in other follow-up studies of osteoarticular infections (8,26), and in several studies sex was not investigated as a risk factor for longterm sequelae (6,7,9,10). However, current literature in the field of general orthopedics suggests that women experience more joint-related pain (27,28).…”

Section: Discussionmentioning

confidence: 88%

“…First, we assessed objective outcomes by physical examination only. This is in contrast with other studies in which diagnostic imaging was performed (6,7,11,26). We were concerned that performing diagnostic imaging routinely as part of the followup study procedures would not be acceptable for many participants and lead to a selection bias in favor of those with ongoing complaints.…”

Section: Discussionmentioning

confidence: 96%

“…In other follow-up studies, which also included children with OM and/or SA, joint involvement as a risk factor was not assessed (7,10). Other outcomes studies included children with either OM or SA and therefore could not assess joint involvement as a risk factor for adverse long-term outcomes (6,9,11,26). The impact of age at onset of illness and the associated skeletal maturity as well as joint involvement as risk factors for adverse outcome of osteoarticular infections should be assessed in a future, prospective study.…”

Section: Discussionmentioning

confidence: 99%

“…Long-term sequelae such as growth disturbance, bone deformity, and chronic infection have been described in 2-40% of patients (6)(7)(8)(9)(10)(11). Septic arthritis of the hip seems to be especially prone for long-term sequelae, which were reported in 47% of affected newborns and in 66% of affected children in a South African study (12,13).…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcomes of Acute Osteoarticular Infections in Children

et al. 2020

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Background: Acute hematogenous osteomyelitis (OM) and septic arthritis require immediate diagnosis and treatment by an interdisciplinary team of pediatric infectious disease specialists and pediatric orthopedic surgeons. Adverse outcomes such as growth disturbance, bone deformity, and chronic infections have been described in older studies. However, there is only little known about long-term follow-up of patients of the last two decades. Therefore, we aimed to evaluate subjective and objective long-term outcomes of these children with osteoarticular infections treated in the millennial years.Methods: Cross-sectional study performed in two pediatric centers including patients admitted for OM and/or SA between 2005 and 2014 and follow-up consultations in 2019. Patients with symptoms of ≤2 weeks duration at initial presentation were contacted. Subjective outcomes were assessed by standardized interview, objective outcomes by clinical examination. Medical charts were used to extract data from the initial presentations. Statistical analysis was performed by non-parametric tests and Fisher's exact test.Results: Of 147 eligible patients 77 (52%) agreed to participate, of which 68 (88%) had an interview and physical examination and 9 (12%) an interview only. Thirty-three (39%) had OM, 26 (34%) SA, and 21 (27%) combined OM/SA. Median (IQR) age at follow-up was 13.3 (10.5–18.0) years with a median (IQR) follow-up of 7.1 (6.1–8.6) years. Persistent complaints including pain, functional differences and scar paresthesia, reported by 21 (28%) patients, were generally mild and only 3 (5%) required ongoing medical care. Objective sequelae including pain, limited range of motion, unilateral axis deformity or asymmetric gait were found in 8 (12%) participants. Older age, female sex, joint involvement, surgical intervention, persistent fever, and C-reactive protein elevation were associated with adverse clinical outcome.Conclusions: Adverse outcomes were observed in a considerable number of patients, most of which were minor, and only few required ongoing medical care. Long-term follow up is advisable for patients with risk factors identified during the initial presentation.This study was registered on ClinicalTrials.gov (NCT03827980).

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Section: Discussionmentioning

confidence: 73%