Adolescents may not show the same musculoskeletal infection symptoms as younger children
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Older children and adolescents may not show the same signs and symptoms of musculoskeletal infection that are common in younger children, according to published results.
To evaluate the presentation and complications of musculoskeletal infections of the extremities and the pelvis in children, researchers analyzed 30 patients from 10 to 17 years of age (mean age of 12.7 years) who had been treated for a range of infections including hematogenous osteomyelitis and septic arthritis.
“Mean time from onset of symptoms to diagnosis was 9.3 days (range of 1 to 30 days),” the researchers wrote in the study. “Twenty-five (83%) of 30 patients were assessed by at least one outpatient provider prior to diagnosis of musculoskeletal infection. Of these, 44% had seen two or more providers before receiving the appropriate diagnosis,” they wrote.
According to the study, 29 (97%) patients underwent MRI, of which 28% (eight of 29 patients) had noncontiguous or multifocal infections.
“More than one-third had serious medical complications or orthopedic sequelae; compared with patients without complications, this group had a significantly higher admission C-reactive protein and longer hospital stay,” the researchers wrote. “Young children with bone or joint infections commonly present with irritability, fever and refusal to bear weight. In this cohort of children 10 years or older, patients nearly universally presented with focal joint or extremity pain; however, the majority were able to partially or fully weight bear and were afebrile,” they added.
The researchers concluded that compared with younger children, older children with musculoskeletal infections often do not present with the same severity of signs and symptoms.
“An elevated C-reactive protein was almost uniformly correlated with intraarticular infection,” the researchers wrote. “Although the trend toward delay in diagnosis and long-term morbidity did not reach statistical significance, prompt recognition and treatment remain imperative because complications and sequelae can be severe,” they added.
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