Sickle Cell Disease in Children Differentiating Osteomyelitis From Vaso-occlusive Crisis
Sickle Cell Disease in Children Differentiating Osteomyelitis From Vaso-occlusive Crisis
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DOI：
10.1001/archpediatrics.2008.545
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发表时间：
2009-03-01
影响因子：
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通讯作者：
Friedman, Jeremy N.
中科院分区：
文献类型：
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作者：
Berger, Elizabeth;Saunders, Natasha;Friedman, Jeremy N.
目的：探讨镰状细胞病伴骨痛的儿童骨髓炎的临床和实验室特征。设计：病例组患者和对照组参与者按1:3的比例随机分组。地点：加拿大安大略省多伦多病童医院。参与者：18岁或以下的镰状细胞病和骨髓炎患者（病例患者）和镰状细胞病和骨、血管闭塞危像患者（对照患者）。主要观察指标：就诊时的5个特征（疼痛部位数量、白细胞计数、患肢肿胀、就诊前疼痛和发热持续时间）。结果：病例31例，对照组93例。与对照组相比，患者在就诊前有更多的疼痛天数（5天vs 2天；优势比[OR]为1.2；95%可信区间[CI]为1.1-1.4天）和发热天数（1天vs 0天；1.7天；1.22.4天）。病例也更有可能出现患肢肿胀（71%对17%；OR, 11.8; 95% CI, 4.6%-30.0%）和更少的疼痛部位（1对2；0.7;0.5-1.0）。在实验室评估中，患者白细胞计数较高（18.6 vs 15.6/ μ L； OR为1.1；95% CI为1.0-1.1/ μ L）。多因素logistic回归分析显示，骨髓炎的显著预测因子为发病前的发热持续时间（OR, 1.8; 95% CI, 1.2-2.6）和疼痛（1.2;1.0-1.4），患肢肿胀（8.4;3.5-20.0）。如果存在一个以上的疼痛部位，骨髓炎的风险降低（OR, 0.7; 95% CI, 0.5-1.0）。结论：镰状细胞病患儿临床表现为单部位骨痛和肿胀，伴长时间发热和疼痛，医生应考虑密切监测和检查，以排除骨髓炎的诊断。
Objective: To identify clinical and laboratory features predictive of osteomyelitis in children with sickle cell disease and bony pain.Design: Patients in the case group and participants in the control group were randomized in a 1: 3 ratio.Setting: The Hospital for Sick Children, Toronto, Ontario, Canada.Participants: Patients with sickle cell disease and osteomyelitis (case patients) and patients with sickle cell disease and bony, vaso-occlusive crisis (control patients), 18 years or younger.Main Outcome Measures: Five characteristics (number of painful sites, white blood cell count, swelling of the affected limb[s], and duration of pain and fever before presentation) at the time of presentation to hospital.Results: Data were analyzed for 31 cases and 93 controls. Compared with controls, cases had more days of pain (5 vs 2 days; odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.4 days) and fever (1 vs 0 day; 1.7; 1.22.4 days) before presentation. Cases were also more likely to have swelling of the affected limb(s) (71% vs 17%; OR, 11.8; 95% CI, 4.6%-30.0%) and fewer painful sites (1 vs 2; 0.7; 0.5-1.0). Onlaboratory evaluation, cases had higher white blood cell counts (18.6 vs 15.6/mu L; OR, 1.1; 95% CI, 1.0-1.1/mu L). Multivariate logistic regression showed that the significant predictors of osteomyelitis were duration of fever (OR, 1.8; 95% CI, 1.2-2.6) and pain (1.2; 1.0-1.4) before presentation and swelling of the affected limb (8.4; 3.5-20.0). The risk of osteomyelitis was decreased if more than 1 painful site was present (OR, 0.7; 95% CI, 0.5-1.0).Conclusion: In the clinical scenario of a child with sickle cell disease presenting with bony pain and swelling affecting a single site, with prolonged fever and pain, the physician should consider closer monitoring and investigations to exclude a diagnosis of osteomyelitis.