Fontalis A, Hughes K, Nguyen M P, Williamson M, Yeo A, Lui D, Gelfer Y
Trauma and Orthopaedic Department, St George's Hospital, London, UK.
St George's University of London, London, UK.
J Child Orthop. 2019 Feb 1;13(1):33-39. doi: 10.1302/1863-2548.12.180094.
The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for these children presenting with bone pain.
A prospective database of children with haemoglobinopathies (2002 to 2017) was analyzed for temperature, C-reactive protein (CRP) and white cell count (WCC) on admission as well as imaging, treatment and cultures. OM diagnosis was supported by imaging and blood cultures. VOC was defined as bone pain that improved without antibiotics.
Over 15 years, 96 children with SCD presented 358 times to hospital. Empirical antibiotics were given in 308 presentations. There were five cases of OM (1.4%); two acute and three chronic. In all, 50 presentations of VOC were identified. No significant differences in age were noted between the OM and VOC group. Temperature and CRP were significantly elevated in the OM group with no significant difference in WCC. Cultures were only positive in the chronic OM admissions. There were no cases of septic arthritis. No surgical intervention was required.
In children with SCD presenting with persistent bone pain, fever, elevated CRP and WCC, OM should be suspected and prompt antibiotic treatment started. Our treatment pathway was successful avoiding OM in 98.6% and septic arthritis in 100%. Further research on novel biological markers distinguishing OM from VOC should be investigated.
III.
小儿镰状细胞病（SCD）骨髓炎（OM）的发病率为0.3%至12%。区分血管闭塞性危机（VOC）和OM是一项诊断挑战，指导治疗的证据有限。我们对一个小儿镰状细胞队列进行了15年的回顾。我们旨在确定OM的发病率，并为这些出现骨痛的儿童提供一个治疗方案。
分析了一个血红蛋白病患儿的前瞻性数据库（2002年至2017年），以获取入院时的体温、C反应蛋白（CRP）和白细胞计数（WCC）以及影像学、治疗和培养结果。OM的诊断通过影像学和血培养来支持。VOC被定义为在未使用抗生素的情况下骨痛得到改善。
在15年期间，96名SCD患儿共358次入院。在308次就诊中给予了经验性抗生素治疗。有5例OM（1.4%）；2例急性和3例慢性。总共确定了50次VOC就诊。OM组和VOC组在年龄上没有显著差异。OM组的体温和CRP显著升高，WCC无显著差异。培养仅在慢性OM入院时呈阳性。没有脓毒性关节炎病例。无需手术干预。
对于出现持续骨痛、发热、CRP和WCC升高的SCD患儿，应怀疑OM并立即开始抗生素治疗。我们的治疗方案成功避免了98.6%的OM和100%的脓毒性关节炎。应进一步研究区分OM和VOC的新型生物标志物。
III级。
