Radiologic Classification of Chronic Hematogenous Osteomyelitis in Children

Abstract

Childhood hematogenous chronic osteomyelitis remains a serious cause of morbidity throughout the developing world. The aim of our study was to develop a reliable and clinically useful classification system for this condition in children. The case notes and radiographs of 87 children with chronic hematogenous osteomyelitis of one or more long bone were reviewed to devise a classification system. We undertook reliability studies of the proposed classification system. Five observers classified the selected radiographs of 32 patients on two separate occasions. The classification divides the condition into 3 main types: type A--Brodie's abscess, type B--sequestrum involucrum, and type C--sclerotic. Type B has four subtypes. Intraobserver agreement was 95% for the main types and 77% (kappa coefficient 0.7) with the subtypes. Interobserver agreement was 95% to 97% for the main types and 78% (multirater kappa=0.54) for the subtypes. The results suggest that our classification system for chronic hematogenous osteomyelitis in children is reliable.