The Journal of Bone and Joint Surgery (American). 2007;89:1517-1523.
doi:10.2106/JBJS.F.01102
© 2007 The Journal of Bone and Joint Surgery, Inc.
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 Pediatrics Test 14: Fall 2007 (publication date November 15, 2007; expirati...
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Deep Venous Thrombosis Associated with Osteomyelitis in Children

S. Tyler Hollmig, BA1, Lawson A.B. Copley, MD2, Richard H. Browne, PhD3, Linda M. Grande, RN, CPNP2 and Philip L. Wilson, MD2

1 University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-9030. E-mail address: tyler.hollmig{at}utsouthwestern.edu
2 Children's Medical Center Dallas, 1935 Motor Street, Dallas, TX 75235
3 Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219

Investigation performed at Children's Medical Center Dallas, Dallas, Texas

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: The association of deep venous thrombosis and deep musculoskeletal infection in children has been reported infrequently. The purpose of the present study was to evaluate the characteristics of children with osteomyelitis in whom deep venous thrombosis developed and to compare them with those of children with osteomyelitis in whom deep venous thrombosis did not develop.

Methods: A retrospective review of the records of children who were managed at our institution because of a deep musculoskeletal infection between January 2002 and December 2004 identified 212 children with osteomyelitis involving the spine, pelvis, or extremities. Children in whom deep venous thrombosis developed were compared with those in whom it did not develop with respect to age, diagnosis, causative organism, duration of symptoms prior to admission, laboratory values at the time of admission, surgical procedures, and required length of hospitalization.

Results: Eleven children with osteomyelitis and deep venous thrombosis were identified. The mean C-reactive protein level was 16.9 mg/dL for the group of eleven patients with osteomyelitis in whom deep venous thrombosis developed, compared with only 6.8 mg/dL for the group of 201 patients with osteomyelitis in whom deep venous thrombosis did not develop (p = 0.0044). Staphylococcus aureus was the causative organism of infection in all eleven children with deep venous thrombosis and in ninety-three (46%) of the 201 children without deep venous thrombosis. Methicillin-resistant strains of Staphylococcus aureus were identified in eight of the eleven children with deep venous thrombosis and in only forty-nine of the 201 children without deep venous thrombosis. The children with osteomyelitis and deep venous thrombosis were older, had a longer duration of hospitalization, had more admissions to the intensive care unit, and required more surgical procedures than those with osteomyelitis but without deep venous thrombosis.

Conclusions: Deep venous thrombosis in association with musculoskeletal infection is more common in children over the age of eight years who have osteomyelitis caused by methicillin-resistant Staphylococcus aureus and who present with a C-reactive protein level of >6 mg/dL. Diagnostic venous imaging studies should be performed to assess for the presence of deep venous thrombosis in children with osteomyelitis, especially those who have these risk factors.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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From the Editor-in-Chief
James D Heckman
JBJS Online, 15 Nov 2007 [Full text]