Table 1.
Demographic and Clinical Characteristics of Patients Enrolled in the Study
| Total | HCH | NCH | |||
|---|---|---|---|---|---|
| Characteristic | (N = 261) | (n = 133) | (n = 128) | Missing | P Value |
| Demographics | |||||
| Age, median (IQR), y | 9.0 (4.2–12.0) | 10.2 (5.8–12.4) | 8.6 (3.7–11.8) | … | .10 |
| Female sex | 102 (39) | 52 (39) | 50 (39) | … | 1.00 |
| Hispanic ethnicity | 29 (11) | 26 (20) | 3 (2) | … | < .001 |
| Race | 1 | .50 | |||
| White | 185 (71) | 94 (71) | 91 (71) | … | |
| African American | 40 (15) | 17 (13) | 23 (18) | … | |
| Asian | 3 (1) | 2 (2) | 1 (1) | … | |
| Other | 32 (12) | 19 (14) | 13 (10) | … | |
| Clinical findings | |||||
| Preceding duration of symptoms, median (IQR), d | 4 (2–7) | 4 (3–7) | 4 (2–7) | … | .22 |
| Location of infectiona | |||||
| Upper extremity long bones | 26 (10) | 14 (11) | 12 (9) | … | .76 |
| Lower extremity long bones | 126 (48) | 63 (47) | 63 (49) | … | .77 |
| Pelvis or sacrum | 49 (19) | 29 (22) | 20 (16) | … | .20 |
| Bones of the hands | 13 (5) | 8 (6) | 5 (4) | … | .43 |
| Bones of the feet | 36 (14) | 17 (13) | 19 (15) | … | .63 |
| Otherb | 8 (3) | 7 (5) | 1 (1) | … | .07 |
| Multifocal infectionc | 12 (5) | 9 (7) | 3 (2) | … | .14 |
| Disseminated infection | 30 (12) | 15 (11) | 15 (12) | … | .91 |
| Admitted to hospital | 257 (99) | 130 (98) | 127 (99) | … | .62 |
| Admitted to ICU | 16 (6) | 10 (8) | 6 (5) | … | .34 |
| Tmaxd, median (IQR), °C | 38.8 (37.739.8) | 38.9 (37.839.9) | 38.7 (37.739.8) | 1 | .07 |
| Duration of fevers in the hospital, median (IQR), d | 2.6 (1.1–4.6) | 2.7 (1.4–4.9) | 2.4 (0.9–4.5) | 1 | .35 |
| Laboratory and radiographic results | |||||
| WBC on admission, median (IQR), ×1000 cells/mL | 10.9 (8.0–15.3) | 10.7 (8.2–15.3) | 10.9 (7.9–15.4) | 19 | .94 |
| ESR on admission, median (IQR), mm/h | 46 (27–58) | 48 (31–68) | 43 (25–52) | 18 | .002 |
| CRP on admission, median (IQR), mg/L | 62 (26–146) | 69 (28–147) | 50 (26–146) | 15 | .87 |
| Suppurative arthritise | 60 (23) | 31 (23) | 29 (23) | … | .90 |
| Plain radiograph | 251 (96) | 128 (96) | 123 (96) | … | 1.00 |
| Magnetic resonance imaging | 250 (96) | 130 (98) | 120 (94) | … | .13 |
| Bone scan | 11 (4) | 8 (6) | 3 (2) | … | .22 |
| Bone abscess | 99 (38) | 46 (35) | 53 (41) | … | .26 |
| Bacteremia | 118 (45) | 60 (45) | 58 (45) | … | .97 |
| Causative organism identifiedf | 191 (73) | 94 (71) | 97 (76) | … | .35 |
| Staphylococcus aureus isolated | 152/191 (80) | 78/94 (83) | 74/97 (76) | … | .89 |
| MRSA isolated | 45/152 (30) | 18/78 (23) | 27/74 (36) | … | .11 |
| Severity of illness scoreg, median (IQR) | 1 (0–5) | 1 (0–5) | 1 (0–5) | 30 | .96 |
| Interventions | |||||
| Any surgical intervention | 165 (63) | 77 (58) | 88 (69) | … | .07 |
| ≥1 bone debridement | 102 (39) | 47 (35) | 55 (43) | … | .21 |
| ≥ 2 bone debridements | 37/102 (36) | 15/47 (32) | 22/55 (40) | … | .40 |
| PICC placed | 97 (37) | 81 (61) | 16 (13) | … | < .001 |
| Duration of antibiotic therapy, median (IQR), d | 33 (29–42) | 35 (30–46) | 32 (28–38) | 14 | .004 |
| Outcomes | |||||
| LOS, median (IQR), d | 4.9 (3.6–7.1) | 5.1 (3.8–7.8) | 4.8 (3.1–6.7) | 4 | .04 |
| Treatment failureh | 27 (10) | 13 (10) | 14 (11) | 1 | .76 |
| Readmission due to adverse events | 17 (7) | 12 (9) | 5 (4) | 1 | .13 |
| Acute complicated courseh | 62 (24) | 29 (23) | 33 (26) | 5 | .45 |
| Chronic morbidityh | 27 (11) | 16 (13) | 11 (9) | 8 | .36 |
Data are presented as no. (%) unless otherwise indicated. Bold values indicate significant results.
Abbreviations: CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; HCH, Hasbro Children’s Hospital; ICU, intensive care unit; IQR, interquartile range; LOS, length of stay; MRSA, methicillin-resistant Staphylococcus aureus; NCH, Nationwide Children’s Hospital; PICC, peripherally inserted central catheter; WBC, white blood cell.
aTotal > 100% secondary to multifocal infections.
bClavicle, scapula, sternum, or patella.
cInvolvement of ≥2 noncontiguous bones.
dMaximum temperature recorded within the first 48 hours of presentation.
eSynovial fluid with positive culture, positive Gram stain for bacteria, nucleated cell count ≥ 10 000 cells/mL, or moderate-many neutrophils if nucleated cell count not done (4 cases).
fIn addition to S. aureus, organisms included Streptococcus pyogenes (n = 18 [9%]), Streptococcus pneumoniae (n = 6 [3%]), Kingella kingae (n = 4 [2%]), Salmonella spp (n = 3 [2%]), Streptococcus agalactiae (n = 3 [2%]), and 1 each of Clostridium perfringens, Escherichia coli, group C Streptococcus, Serratia marcescens, and Streptococcus anginosus.
gAs described by Athey et al [30].
hDefined in Methods section.