Diagnostic efficacy of metaepiphyseal osteomyelitis in young children: a prospective study

Abstract

INTRODUCTION: Modern and effective diagnosis of osteomyelitis is the basis for successful therapy; at the same time the problem of establishing this pathology, especially in the early stages of the development of the process, has not been completely resolved.OBJECTIVE: To develop of ultrasound imaging of metaepiphyseal osteomyelitis in young children, depending on the duration of the disease.MATERIAL AND METHODS: 108 children (boys — 65% (70/108), girls — 35 (38/108)) from 1 month to 2 years were examined. Children's age from 2 up to 8 months — 57% (62/108), newborns — 26% (27/108). The age of other children: 12% (13/108) — 9–12 months, 5% (6/108) — 1– 2 years. All children underwent x-ray and ultrasound study. The diagnosis of osteomyelitis was verified by joint puncture (n=102), bone puncture (n=57), drainage of periarticular phlegmon (n=12).Statistics: processing of the study results was carried out using the Statistica 13.0 application package (TIBCO Software Inc, 2017). To assess the effectiveness of ultrasound in the diagnosis of acute osteomyelitis, the diagnostic effectiveness and predictive value of positive or negative results were calculated, and the likelihood ratio was calculated.RESULTS: 3 groups were identified depending on the duration of the disease at the time of admission to the hospital: Ia — 1–3 days, Ib — 4–7 days, Group II — 8–14 days, Group III — 15–21 days from the onset of the disease. DE indicators for patients of group Ia: sensitivity — 81.8%, specificity — 60.0%, accuracy — 75%, PV(+)=81.82%; PV(–)=60.00%; OR=4.50. DE indicators for patients in group Ib: sensitivity — 86.6%, specificity — 66.6%, accuracy — 80.95%, PV(+)=87.5%; PV(–)=60.0%; OR=7.00. DE indicators for patients in group II: sensitivity — 92.98%, specificity — 80.0%, accuracy — 93.44%, PV(+)=98.15%; PV(–)=57.14%; OR=37.86. DE indicators for patients of group III: sensitivity — 91.66%, specificity — 91.0%, accuracy — 91.66%, PV(+)=100.0%.DISCUSSION: Ultrasound imaging of acute osteomyelitis in children of group Ia included nonspecific changes in periarticular tissues and had the lowest diagnostic accuracy (75%). Diagnostic accuracy increased in group Ib to 85% due to initial structural changes in the zone of preliminary calcification and hyaline cartilage of the epiphysis. Disease progression in group II was characterized by more distinct structural changes in the metaphysis with an increase in diagnostic accuracy to 93%. In patients of group III, the highest rates of diagnostic accuracy (91.67%) were obtained due to visualization of destructive changes in the epiphysis, metaphysis and zone of preliminary calcification.CONCLUSION: The ability to detect ultrasound signs of acute hematogenous metaepiphyseal osteomyelitis in children will allow the use of this method in the early diagnosis for the timely selection of an adequate treatment tactics.