Severity Adjusted Risk of Long-term Adverse Sequelae Among Children With Osteomyelitis. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Vorhies, John S.; Lindsay, Eduardo A.; Tareen, Naureen G.; Kellum, Rodney J.; Jo, Chan Hee; Copley, Lawson A.
• Is Part Of: Pediatric infectious disease journal. Volume 38:Issue 1(2019)
• Publication Date: 2019-01
• Subjects: long-term outcomes -- pediatric osteomyelitis -- severity of illness; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000002044
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: The purpose of this investigation was to evaluate the risk for long-term, adverse outcomes among children with osteomyelitis. Methods: Children with osteomyelitis were prospectively enrolled from 2012 to 2014. Care was accomplished by a multidisciplinary team according to an institutional algorithm. Data were collected to define the severity of illness during the initial hospitalization and assess short, intermediate and long-term outcomes. Clinical examination, radiographic assessment and functional outcome survey administration were performed at a minimum of 2 year follow-up. A comparison cohort analysis was performed according to initial severity of illness score of mild (0–2), moderate (3–6) and severe (7–10). Results: Of 195 children enrolled, 139 (71.3%) returned for follow-up at an average of 2.4 years (range, 2.0–5.0 years). Children with severe illness were less likely to have normal radiographs (severe, 4.0%; moderate, 38.2%; mild, 53.2%, P < 0.0001), and more likely to have osteonecrosis, chondrolysis, or deformity (severe, 32.0%; moderate, 5.9%; mild, 1.3%, P < 0.0001). Functional outcome measures did not significantly differ between severity categories. By regression analysis severity of illness score, plus age less than 3 years and Methicillin-resistant Staphylococcus aureus predicted severe sequelae with an area under the curve of 0.8617 and an increasing odds ratio of 1.34 per point of increase in severity score. Conclusion: Long-term severe adverse outcomes among children with osteomyelitis occurred in 11 of 139 (7.9%) children and were predicted by initial severity of illness. Other risks that diminished the likelihood of complete resolution or increased the risk of severe sequelae included Methicillin-resistant Staphylcoccus aureus etiology and young age. The majority of children with osteomyelitis do not require long-term follow-up beyond the initial treatment period.