Analysis of clinical features of children with tendency of skin soft tissue infection to osteomyelitis
10.3760/cma.j.cn121113-20230607-00320
- VernacularTitle:以皮肤软组织感染为主要征象的儿童急性骨髓炎发病初期的临床特征
- Author:
Haiting JIA
1
;
Yuting WANG
;
Lin SUN
;
Tao LIU
;
Jiazhi YU
;
Shifu WANG
Author Information
1. 山东大学附属儿童医院（济南市儿童医院）骨科创伤外科，济南 250022
- Keywords:
Child;
Soft tissue infections;
Osteomyelitis
- From:
Chinese Journal of Orthopaedics
2023;43(21):1427-1432
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical features of the initial phase of acute osteomyelitis in children with skin and soft tissue infection as the main sign.Methods:The clinical data of 154 children with skin and soft tissue infections as the main sign from July 2017 to February 2023 were retrospectively analyzed. According to MRI, 48 children with no signs of osteomyelitis and only simple skin and soft tissue infection were included in the non-osteomyelitis group, including 28 boys and 20 girls, aged 38.50 (12.00, 93.00) months; 106 children with acute osteomyelitis with skin and soft tissue infection as the main sign were included in the osteomyelitis group, including 65 boys and 41 girls, aged 49.50 (17.50, 87.00) months. The disease course, maximum body temperature at onset, inflammatory indicators (including white blood cell count, neutrophil count, C-reactive protein, erythrocyte sedimentation rate) examined within 24 h after admission were compared between the two groups, and receiver operating characteristic (ROC) curve was used to evaluate the efficacy of each index in diagnosing osteomyelitis.Results:The white blood cell counts in the non-osteomyelitis group and osteomyelitis group were 13.72 (10.19, 19.19) ×10 9 /L and 14.74 (10.63, 18.67) ×10 9 /L, and the neutrophil counts were 7.79 (5.62, 11.91) ×10 9 /L and 9.58 (5.77, 13.67) ×10 9 /L, the difference was not statistically significant ( Z=-0.68, P=0.495; Z=-1.24, P=0.216). The course of disease in the non-osteomyelitis group and osteomyelitis group was 5.00 (3.00, 7.00) d and 5.50 (4.00, 9.00) d ( Z=-2.03, P=0.042), and the maximum body temperature at the onset of the disease was 38.50 (36.65, 39.00) ℃ and 39.00 (38.50, 40.00) ℃ ( Z=-3.72, P<0.001), C-reactive protein was 23.26 (8.16, 47.67) mg/L and 69.27 (26.28, 111.03) mg/L ( Z=-4.52, P<0.001), erythrocyte sedimentation rate was 35.00 (24.25, 53.00) mm/1 h and 61.00 (43.00, 78.00) mm/1 h ( Z=-5.06, P<0.001), the differences were statistically significant. The proportion of patients with increased C-reactive protein was 70.8% (34/48) and 92.5% (98/106) in non-osteomyelitis group and osteomyelitis group, the proportion of patients with increased erythrocyte precipitation rate was 81.3% (39/48) and 100% (106/106), and the proportion of patients with fever was 66.7% (32/48) and 100% (106/106), respectively, the difference was statistically significant (χ 2=12.61, P<0.001; χ 2=21.11, P<0.001; χ 2=39.43, P<0.001). The sensitivity, specificity and area under the curve of osteomyelitis were 84.0%, 33.3% and 0.602, respectively. The maximum body temperature at onset was 99.1%, 35.4% and 0.687, and the C-reactive protein was 57.6%, 85.4% and 0.728, respectively. Erythrocyte sedimentation rates were 84.0%, 56.3% and 0.755, respectively. Multivariate logistic regression analysis indicated that the maximum body temperature was >37.6 ℃ [ OR=22.54, 95% CI (2.66, 190.81)] and C-reactive protein was >54.59 mg /L [ OR=4.23, 95% CI (1.63, 11.01)] was an independent risk factor for predicting osteomyelitis with skin and soft tissue infection as the main sign. Conclusion:Compared to simple skin and soft tissue infections, children with osteomyelitis had a higher proportion of fever, elevated C-reactive protein, and elevated erythrocyte sedimentation rate, a longer duration of illness, and higher elevations in temperature, C-reactive protein, and erythrocyte sedimentation rate. Length of onset, maximum body temperature at onset, C-reactive protein and erythrocyte sedimentation rate had certain diagnostic efficacy in determining the tendency of skin soft tissue infection to osteomyelitis. Maximum body temperature >37.6 ℃ and C-reactive protein >54.59 mg/L may independently predict the possibility of skin soft tissue infection as osteomyelitis, and prompt Magnetic Resonance Imaging is recommended for early diagnosis and treatment in such children.
