When a patient presents with fever, pain in an extremity, and decreased mobility, the differential diagnosis can be quite broad. The danger is that the work-up could delay the diagnosis and treatment of acute hematogenous osteomyelitis (AHO), which requires rapid intervention. Definitive diagnosis of AHO requires a magnetic resonance imaging (MRI) scan or a bone biopsy, both of which can delay therapy. That is why it would be great to have some predictive clues based on easily available clinical and laboratory factors. In an article being early released this month in Pediatrics, Stephan et al. (10.1542/peds.2023-063153) share the results of a retrospective matched case-control study of 1135 cases of AHO matched to 2270 controls with patients from 23 pediatric emergency departments in the national Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.
The authors identified 10 clinical and laboratory factors independently associated with AHO, and from these factors derived a 4-point risk score based on (1) duration of illness >3 days; (2) history of fever or an emergency department temperature ≥380 C; (3) C-reactive protein >2.0 mg/dl; and (4) erythrocyte sedimentation rate >25 mm/hr. If three of these factors are present, the authors found the diagnostic accuracy to be 84%, and if none of these factors are present, the sensitivity of not having AHO was 99%. The authors note some limitations to their predictive scoring system and the need for its external validation. However, using this scoring system could be very helpful in clinical decision-making regarding getting that MRI or bone biopsy for a patient with fever and extremity pain during the early stages of a workup.
Would you use this scoring system on your patients with fever, pain, and decreased mobility? The authors are throwing a clinical bone to you that they believe can help you be more timely in your diagnostic workup for AHO, so link to this study and learn in more detail about all that went into deriving this predictive scoring system.
