Original articleVenous thrombosis and thromboembolism in children with osteomyelitis
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.
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Supported in part by NIH Institutional National Research Service Award T32 CA 09640 and The Hemophilia and Thrombosis Research Society.