1130. Descriptive Epidemiology of the Radiographic Findings in Pediatric Osteomyelitis with a Focus on Plain Films: A Five Year Experience at a Tertiary Children’s Hospital
Session: Poster Abstract Session: Clinical Infectious Diseases: Bone and Joint, Skin and Soft Tissue
Friday, October 28, 2016
Room: Poster Hall
  • IDSA Poster Presentation_FINAL_pdf.pdf (331.0 kB)
  • Background: MRI is the gold standard in the radiographic diagnosis of pediatric osteomyelitis (OM). Plain film is recommended in the work-up but has low sensitivity in acute disease. The optimal role of x-ray in the diagnosis of OM in pediatrics is unclear.

    Methods: We performed a retrospective chart review of patients diagnosed with OM from 2011 to 2015. Criteria were applied to capture healthy children with long bone OM. We divided patients into acute (symptoms ≤14 days) and sub-acute (>14 days) groups. We recorded age, duration of symptoms, infection location, WBC count, CRP, ESR, and culture results. We noted the presence of soft tissue and bone abnormalities on x-rays. MRI findings included the presence of complicated disease. We compared acute and sub-acute OM. We determined whether abnormal plain films were associated with clinical findings and a higher likelihood of complicated disease.

    Results: 89 of 368 patients were included. 81 had acute OM, 8 sub-acute. 62.3% of patients with acute OM had positive blood cultures. Surgical cultures were positive in 85.2% of acute OM. Mean CRP was 11.4mg/dl (acute) and 4.2 (sub-acute). Mean ESR 60.6mm/hr (acute) and 63 (sub-acute). Mean WBC 13.4 (acute) and 10.2 (sub-acute). For acute OM, mean CRP for MSSA and MRSA was 11.9 and 18.2; mean ESR for MSSA and MRSA was 67.2 and 83.7. 84 patients had x-rays obtained. 35 (42%) were abnormal (57% soft tissue, 43% bone abnormalities). Sub-acute patients were more likely to have bony changes on x-ray versus acute (71% vs 13%). Soft tissue findings on x-ray were more common in acute OM due to MRSA vs MSSA (39 vs 26%) but there was no difference in presence of bony abnormalities. 3 of 4 cases with DVT had MRSA. 75% of patients with bony abnormalities on plain film had corresponding bony complications on MRI. 

    Conclusion: Patients with sub-acute OM were more likely to have abnormal bony findings on plain film. However, a surprising number of patients with acute disease had abnormal plain films, including bony findings. Bony findings on x-ray correlated with bony complications on MRI. Plain films continue to play a valuable role in the diagnostic workup of OM.


    Natalia Liu, Medical Student, Indiana University School of Medicine, Indianapolis, IN and Thomas Fox, MD, Pediatrics, Indiana University School of Medicine, Indianapolis, IN


    N. Liu, None

    T. Fox, None

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