Clinical and laboratory parameters associated with multiple surgeries in children with acute hematogenous osteomyelitis.

ABSTRACT

BACKGROUND: In the era of methicillin-resistant Staphylococcus aureus, surgical intervention seems to be increasingly common as an adjunct to treatment for pediatric acute hematogenous osteomyelitis (AHO). The purpose of this study is to identify objective clinical and laboratory parameters that are associated with repeated surgical intervention during the acute phase of treatment. METHODS: Fifty-seven children who were consecutively evaluated and treated for AHO at a single institution during 2009 were studied retrospectively. Objective clinical and laboratory parameters related to length of hospitalization were recorded for each child. Univariate analysis was performed with ordinal logistic regression, χ, Fisher exact, and Wilcoxon rank-sum and 2-value tests to identify independent variables associated with the occurrence of surgery in children with AHO. Multivariate logistic regression was used to identify parameters associated with repeated surgical intervention. RESULTS: Sixteen children were treated with antibiotics alone and no surgery. There were 41 children who had at least 1 surgery and 12 who underwent ≥2 surgeries. Multiple logistic regression showed that a swollen extremity (P=0.002), initial C-reactive protein (CRP) value >9.9 mg/dL (P=0.02), and respiration rate >27 breaths/min (P=0.02) were significantly associated with the occurrence of at least 1 surgery. The best model to identify the occurrence of repeated surgical intervention in children with AHO included ≥4 febrile days on antibiotics; and the CRP values at admission (>19.8 mg/dL), 48 hours after the initial surgery (>21.5 mg/dL), and 96 hours after the initial surgery (>15.3 mg/dL). CONCLUSIONS: Children with AHO who have sustained marked elevation of CRP values during the first 96 hours after surgery and who remain febrile while on antibiotics have an increased likelihood of repeated surgical intervention and should be evaluated carefully for additional surgical treatment. LEVEL OF EVIDENCE Level III, retrospective comparative study.