Assessing risk for complications in acute hematogenous osteomyelitis in children. Validation of two predictive scores.

Abstract

Acute hematogenous osteomyelitis (AHO) can be associated with severe complications which can be difficult to predict in the clinical setting. The previously published predictive acute complication score ("A-SCORE") and chronic complication score ("C-SCORE") show promise, however, further external validation is needed. We performed a retrospective study of 418 children with AHO and analyzed the performance of A-SCORE (variables included bone abscess, fever after 48 hours of starting antibiotics, suppurative arthritis, disseminated disease and delayed source control) to predict risk for acute complicated course (treatment failure, prolonged admission, and/or need for ≥ 2 bone debridements) and C-SCORE (includes disseminated disease, bone debridement and CRP ≥10mg/dl at 2-4 days after starting antibiotics) to predict chronic complications (growth restriction, pathologic fracture, chronic osteomyelitis, avascular necrosis, joint deformity and/or frozen joint). An acute complicated course occurred in 106/418 (25.4%); 51/380 (13.5%) with complete follow-up data had a chronic complication. The A-SCORE performed with similar specificity (78%) and negative predictive value (NPV) (92%), and higher sensitivity (81%) and increased area under the receiver operating curve (AUC) (0.87) in our population. The C-SCORE performed with similar sensitivity (64%) and NPV (94%) but had lower specificity (86%) and AUC (0.71) than originally reported. Other variables associated with development of complications such as tibia involvement and bacteremia ≥ 2 days were identified but did not result in significantly improved predictive scores. Predictive A-SCORE and C-SCORE for AHO complications in children may help guide acute management and long-term follow up decisions. Prospective studies are needed to determine their applicability.