Accelerated Severity of Illness Score Enhances Prediction of Complicated Acute Hematogenous Osteomyelitis in Children.

Autor:	Jahan TA; From the Department of Pediatric Infectious Disease, Seattle Children's Hospital, University of Washington, Seattle, Washington., Lapin NA; Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Center for Pediatric Bone Biology and Translational Research; Dallas, Texas., O'Connell MT; Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Center for Pediatric Bone Biology and Translational Research; Dallas, Texas., Jo C; Department of Clinical Orthopaedic Research, Scottish Rite for Children., Ma Y; Department of Clinical Orthopaedic Research, Scottish Rite for Children., Tareen NG; Department of Pediatric Orthopaedic Surgery, Children's Medical Center-Dallas, Dallas, Texas., Copley LA; Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Center for Pediatric Bone Biology and Translational Research; Dallas, Texas.; Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern Medical Center.; Department of Pediatric Orthopaedic Surgery, Children's Health System of Texas, Dallas, Texas.
Jazyk:	angličtina
Zdroj:	The Pediatric infectious disease journal [Pediatr Infect Dis J] 2024 Sep 05. Date of Electronic Publication: 2024 Sep 05.
DOI:	10.1097/INF.0000000000004535
Abstrakt:	Background: Severity of illness determination for children with acute hematogenous osteomyelitis should be accomplished during the earliest stages of evaluation to guide treatment and establish prognosis. This study objectively defines an outcome of complicated osteomyelitis and explores an illness severity-based model with an improved ability to predict this outcome as soon and accurately as possible, comparing it to existing models. Methods: Children with Staphylococcus aureus acute hematogenous osteomyelitis (n = 438) were retrospectively studied to identify adverse events and predictors of severity. The outcome of complicated osteomyelitis was ultimately defined as the occurrence of any major or at least 3 minor adverse events, which occurred in 52 children. Twenty-four clinical and laboratory predictors were evaluated through univariate and stacked multivariable regression analyses of chronologically distinct groups of variables. Receiver operating characteristic curve analyses were conducted to compare models. Results: Accelerated Severity of Illness Score included: triage tachycardia [odds ratio: 10.2 (95% confidence interval: 3.48-32.3], triage tachypnea [6.0 (2.4-15.2)], C-reactive proteininitial ≥17.2 mg/dL [4.5 (1.8-11.8)], white blood cell count band percentageinitial >3.8% [4.6 (2.0-11.0)], hemoglobininitial ≤10.4 g/dL [6.0 (2.6-14.7)], methicillin-resistant S. aureus [3.0 (1.2-8.5)], septic arthritis [4.5 (1.8-12.3)] and platelet nadir [7.2 (2.7-20.4)]. The receiver operating characteristic curve of Accelerated Severity of Illness Score [area under the curve = 0.96 (0.941-0.980)] were superior to those of Modified Severity of Illness Score = 0.903 (0.859-0.947), Acute Score for Complications of Osteomyelitis Risk Evaluation = 0.878 (0.830-0.926) and Chronic Score for Complications of Osteomyelitis Risk Evaluation = 0.858 (0.811-0.904). Successive receiver operating characteristic curve analyses established an exponentially increasing risk of complicated osteomyelitis for children with mild (0/285 or 0%), moderate (4/63 or 6.3%), severe (15/50 or 30.0%) and hyper-severe (33/40 or 82.5%) acute hematogenous osteomyelitis (P<0.0001). Conclusions: This study improves upon previous severity of illness models by identifying early predictors of a rigorously defined outcome of complicated osteomyelitis. Competing Interests: The authors have no funding or conflicts of interest to disclose. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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