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Dilemma in differentiating between acute osteomyelitis and bone infarction in children with sickle cell disease: the role of ultrasound.

Inusa BP, Oyewo A, Brokke F, Santhikumaran G, Jogeesvaran KH - PLoS ONE (2013)

Bottom Line: Mean C-reactive protein (CRP), and white cell count (WCC) were significantly higher in the OM.The use of Ultrasound in combination with CRP and WCC is a reliable, cost-effective diagnostic tool for differentiating osteomyelitis from VOC bone infarction in SCD.A repeat ultrasound and/or magnetic resonance imaging (MRI) scan may be is necessary to confirm the diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, Evelina Children's Hospital, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom. baba.inusa@gstt.nhs.uk

ABSTRACT

Background: Distinguishing between acute presentations of osteomyelitis (OM) and vaso-occlusive crisis (VOC) bone infarction in children with sickle cell disease (SCD) remains challenging for clinicians, particularly in culture-negative cases. We examined the combined role of ultrasound scan (USS), C - reactive protein and White blood counts (WCC) in aiding early diagnosis in children with SCD presenting acutely with non-specific symptoms such as bone pain, fever or swelling which are common in acute osteomyelitis or VOC.

Methods: We reviewed the records of all children with SCD who were discharged from our department from October 2003 to December 2010 with a diagnosis of osteomyelitis based on clinical features and the results of radiological and laboratory investigations. A case control group with VOC who were investigated for OM were identified over the same period.

Results: In the osteomyelitis group, USS finding of periosteal elevation and/or fluid collection was reported in 76% cases with the first scan (day 0-6). Overall 84% were diagnosed with USS (initial +repeat). 16% had negative USS. With VOC group, USS showed no evidence of fluid collection in 53/58 admissions (91%), none of the repeated USS showed any fluid collection. Mean C-reactive protein (CRP), and white cell count (WCC) were significantly higher in the OM.

Conclusion: The use of Ultrasound in combination with CRP and WCC is a reliable, cost-effective diagnostic tool for differentiating osteomyelitis from VOC bone infarction in SCD. A repeat ultrasound and/or magnetic resonance imaging (MRI) scan may be is necessary to confirm the diagnosis.

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Related in: MedlinePlus

Maximum CRP range (day 0–4) in the osteomyelitis (OM) and vaso-occlusive crisis (VOC) group.
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pone-0065001-g003: Maximum CRP range (day 0–4) in the osteomyelitis (OM) and vaso-occlusive crisis (VOC) group.

Mentions: The radiology information system (Clinical Research Information System, CRIS) was interrogated to identify all paediatric patients aged 0 to 18 years age who were admitted to our department over a period of 7 years and 2 months (October 2003 to December 2010) with suspected osteomyelitis or VOC and underwent imaging studies as part of the diagnostic work-up see Figure 1 & 2. This information was cross-checked with the SCD database. Chronic OM was excluded. Patient case notes and Electronic Patient Records (EPR) were examined to collect data including symptoms at presentation and results of laboratory investigations including WCC), CRP (Figure 3), blood culture results and bone or joint aspirate results. Findings from surgical interventions where applicable, were also recorded.


Dilemma in differentiating between acute osteomyelitis and bone infarction in children with sickle cell disease: the role of ultrasound.

Inusa BP, Oyewo A, Brokke F, Santhikumaran G, Jogeesvaran KH - PLoS ONE (2013)

Maximum CRP range (day 0–4) in the osteomyelitis (OM) and vaso-occlusive crisis (VOC) group.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3675051&req=5

pone-0065001-g003: Maximum CRP range (day 0–4) in the osteomyelitis (OM) and vaso-occlusive crisis (VOC) group.
Mentions: The radiology information system (Clinical Research Information System, CRIS) was interrogated to identify all paediatric patients aged 0 to 18 years age who were admitted to our department over a period of 7 years and 2 months (October 2003 to December 2010) with suspected osteomyelitis or VOC and underwent imaging studies as part of the diagnostic work-up see Figure 1 & 2. This information was cross-checked with the SCD database. Chronic OM was excluded. Patient case notes and Electronic Patient Records (EPR) were examined to collect data including symptoms at presentation and results of laboratory investigations including WCC), CRP (Figure 3), blood culture results and bone or joint aspirate results. Findings from surgical interventions where applicable, were also recorded.

Bottom Line: Mean C-reactive protein (CRP), and white cell count (WCC) were significantly higher in the OM.The use of Ultrasound in combination with CRP and WCC is a reliable, cost-effective diagnostic tool for differentiating osteomyelitis from VOC bone infarction in SCD.A repeat ultrasound and/or magnetic resonance imaging (MRI) scan may be is necessary to confirm the diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, Evelina Children's Hospital, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom. baba.inusa@gstt.nhs.uk

ABSTRACT

Background: Distinguishing between acute presentations of osteomyelitis (OM) and vaso-occlusive crisis (VOC) bone infarction in children with sickle cell disease (SCD) remains challenging for clinicians, particularly in culture-negative cases. We examined the combined role of ultrasound scan (USS), C - reactive protein and White blood counts (WCC) in aiding early diagnosis in children with SCD presenting acutely with non-specific symptoms such as bone pain, fever or swelling which are common in acute osteomyelitis or VOC.

Methods: We reviewed the records of all children with SCD who were discharged from our department from October 2003 to December 2010 with a diagnosis of osteomyelitis based on clinical features and the results of radiological and laboratory investigations. A case control group with VOC who were investigated for OM were identified over the same period.

Results: In the osteomyelitis group, USS finding of periosteal elevation and/or fluid collection was reported in 76% cases with the first scan (day 0-6). Overall 84% were diagnosed with USS (initial +repeat). 16% had negative USS. With VOC group, USS showed no evidence of fluid collection in 53/58 admissions (91%), none of the repeated USS showed any fluid collection. Mean C-reactive protein (CRP), and white cell count (WCC) were significantly higher in the OM.

Conclusion: The use of Ultrasound in combination with CRP and WCC is a reliable, cost-effective diagnostic tool for differentiating osteomyelitis from VOC bone infarction in SCD. A repeat ultrasound and/or magnetic resonance imaging (MRI) scan may be is necessary to confirm the diagnosis.

Show MeSH
Related in: MedlinePlus