Journal
JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY
Volume -, Issue -, Pages -Publisher
OXFORD UNIV PRESS
DOI: 10.1093/jpids/piad095
Keywords
acute hematogenous osteomyelitis; complications; score
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In this retrospective study of children with acute hematogenous osteomyelitis, the A-SCORE and C-SCORE were found to be useful in predicting acute and chronic complications, respectively. These scores can aid in guiding acute management and long-term follow-up decisions.
Background Acute hematogenous osteomyelitis (AHO) can be associated with severe complications which can be difficult to predict in the clinical setting. The previously published predictive acute complication score (A-SCORE) and chronic complication score (C-SCORE) show promise, however, further external validation is needed.Methods We performed a retrospective study of 418 children with AHO and analyzed the performance of A-SCORE (variables included bone abscess, fever after 48 h of starting antibiotics, suppurative arthritis, disseminated disease, and delayed source control) to predict risk for acute complicated course (treatment failure, prolonged admission, and/or need for >= 2 bone debridements) and C-SCORE (includes disseminated disease, bone debridement, and CRP >= 10 mg/dL at 2-4 days after starting antibiotics) to predict chronic complications (growth restriction, pathologic fracture, chronic osteomyelitis, avascular necrosis, joint deformity, and/or frozen joint).Results An acute complicated course occurred in 106/418 (25.4%); 51/380 (13.5%) with complete follow-up data had a chronic complication. The A-SCORE performed with similar specificity (78%) and negative predictive value (NPV) (92%), and higher sensitivity (81%) and increased area under the receiver operating curve (AUC) (0.87) in our population. The C-SCORE performed with similar sensitivity (64%) and NPV (94%) but had lower specificity (86%) and AUC (0.71) than originally reported. Other variables associated with development of complications such as tibia involvement and bacteremia >= 2 days were identified but did not result in significantly improved predictive scores.Conclusions Predictive A-SCORE and C-SCORE for AHO complications in children may help guide acute management and long-term follow-up decisions. Prospective studies are needed to determine their applicability. Acute hematogenous osteomyelitis in children has a variable presentation and may result in severe complications. We validated published predictive scores to assess the risk for complications within the first 96 h of admission in a diverse patient population.
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