Venous thrombosis and thromboembolism in children with osteomyelitis

Objective

To determine the prevalence and clinical features of deep vein thrombosis (DVT) complicating osteomyelitis during childhood.

Study design

We retrospectively reviewed medical records of all patients with osteomyelitis admitted to Children’s Medical Center Dallas between July 1, 2003 and December 31, 2004. Analysis was performed on patients with proximal upper or lower extremity, pelvic or vertebral osteomyelitis (a subgroup considered to be at highest risk for infection-related thrombosis).

Results

Thirty-five patients had confirmed osteomyelitis of the proximal humerus, proximal tibia/fibula, femur, pelvis, or vertebrae. Ten of these 35 children (29%) developed DVT during the acute infection based on imaging studies performed. Eight thrombi occurred adjacent to the infection and two occurred in relation to central venous catheters. Six of the 10 children with DVT also had evidence of infection disseminated to lung, brain, or heart, compared with only 1 of 25 patients without DVT (P = .001). Hospitalization was longer in those with DVT than without (33.5 v. 14.2 days, P = .001).

Conclusion

Thromboembolic complications can occur in the setting of osteomyelitis, and affected patients may be at higher risk of disseminated infection.

Abbreviations: CRP, C-reactive protein, CT, Computed tomography, DVT, Deep venous thrombosis, ESR, Erythrocyte sedimentation rate, IV, Intravenous, MRI, Magnetic resonance imaging, MRSA, Methicillin-resistant Staphylococcus aureus, MSSA, Methicillin-sensitive Staphylococcus aureus, MRV, Magnetic resonance venography, PVL, Panton-Valentine leukocidin, WBC, White blood cell