Original article
Venous thrombosis and thromboembolism in children with osteomyelitis

https://doi.org/10.1016/j.jpeds.2006.06.067Get rights and content

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.

Section snippets

Methods

All patients with acute osteomyelitis admitted to Children’s Medical Center Dallas between July 1, 2003 and December 31, 2004 were identified retrospectively through an International Classification of Diseases, 9th Revision (ICD-9) search of the medical records. This 18-month period was chosen because of our recent recognition of an apparent association of osteomyelitis and DVT at our institution. The study was approved by the Institutional Review Board of the University of Texas Southwestern

Location and Cause of Infections

Fifty-two patients with acute osteomyelitis were diagnosed and treated at Children’s Medical Center Dallas between July 1, 2003 and December 31, 2004. Seventeen had osteomyelitis of excluded sites: ankle (n = 9), foot (n = 6), distal upper extremity (n = 1), and cranium (n = 1). Thirty-five (67%) children had osteomyelitis involving the proximal humerus, femur, proximal tibia or fibula, pelvis, or vertebrae and were therefore included in the analysis. Thirty-four children were previously

Discussion

We observed that acute osteomyelitis in children can be associated with DVT. We speculate that this previously underappreciated association can occur because of the inflammation associated with the bone infection, which leads to localized endothelial damage and release of inflammatory cytokines resulting in activation of the coagulation cascade, thrombin generation and fibrin deposition.2 This process is compounded by local edema and external venous compression contributing to venous stasis.

References (15)

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Supported in part by NIH Institutional National Research Service Award T32 CA 09640 and The Hemophilia and Thrombosis Research Society.

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