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The challenge of differentiating vaso-occlusive crises from osteomyelitis in children with sickle cell disease and bone pain: A 15-year retrospective review

Fontalis, A; Hughes, K; Nguyen, MP; Williamson, M; Yeo, A; Lui, D; Gelfer, Y (2019) The challenge of differentiating vaso-occlusive crises from osteomyelitis in children with sickle cell disease and bone pain: A 15-year retrospective review. JOURNAL OF CHILDRENS ORTHOPAEDICS, 13 (1). pp. 33-39. ISSN 1863-2521 https://doi.org/10.1302/1863-2548.13.180094
SGUL Authors: Gelfer, Yael

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Abstract

Purpose The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for these children presenting with bone pain. Methods A prospective database of children with haemoglobinopathies (2002 to 2017) was analyzed for temperature, C-reactive protein (CRP) and white cell count (WCC) on admission as well as imaging, treatment and cultures. OM diagnosis was supported by imaging and blood cultures. VOC was defined as bone pain that improved without antibiotics. Results Over 15 years, 96 children with SCD presented 358 times to hospital. Empirical antibiotics were given in 308 presentations. There were five cases of OM (1.4%); two acute and three chronic. In all, 50 presentations of VOC were identified. No significant differences in age were noted between the OM and VOC group. Temperature and CRP were significantly elevated in the OM group with no significant difference in WCC. Cultures were only positive in the chronic OM admissions. There were no cases of septic arthritis. No surgical intervention was required. Conclusion In children with SCD presenting with persistent bone pain, fever, elevated CRP and WCC, OM should be suspected and prompt antibiotic treatment started. Our treatment pathway was successful avoiding OM in 98.6% and septic arthritis in 100%. Further research on novel biological markers distinguishing OM from VOC should be investigated. Level of Evidence III

Item Type: Article
Additional Information: Copyright © 2019, The author(s) This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
Keywords: sickle cell disease, vaso-occlusive crisis, osteomyelitis, sickle cell disease, vaso-occlusive crisis, osteomyelitis, 1114 Paediatrics And Reproductive Medicine, Orthopedics
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Journal or Publication Title: JOURNAL OF CHILDRENS ORTHOPAEDICS
ISSN: 1863-2521
Dates:
DateEvent
February 2019Published
11 December 2018Published Online
15 November 2018Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
Web of Science ID: WOS:000458035700004
URI: http://sgultest.da.ulcc.ac.uk/id/eprint/110743
Publisher's version: https://doi.org/10.1302/1863-2548.13.180094

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