When should DVT be suspected in children with osteomyelitis?

BACKGROUND There is increasing recognition that deep venous thrombosis (DVT) is a complicating factor in some children with acute hematogenous osteomyelitis. The similarity in signs and symptoms of osteomyelitis and DVT make clinical recognition of this complicating condition difficult. It would be helpful to the clinician to identify by other means which children with osteomyelitis are at greatest risk for DVT. We reviewed the available literature regarding osteomyelitis and DVT in children to identify potential characteristics of children with osteomyelitis that puts them at risk for concurrent DVT. METHODS We performed searches of the PubMed, Cochrane, CINAHL, and National Guideline Clearinghouse databases on the topic of osteomyelitis and thrombosis in children 0 to 18 years of age from 2001 to the present. RESULTS Four studies were included: 3 retrospective and 1 prospective. Studies varied in terms of clinical, laboratory, and imaging parameters evaluated. Overall they suggest trends toward increased incidence of DVT in children who were critically ill at presentation, had positive blood cultures, were infected with methicillin-resistant Staphylococcus aureus, had an elevated C-reactive protein, and had central venous catheters placed. CONCLUSIONS Strong consideration should be given to evaluating children with osteomyelitis for DVT if they are critically ill at presentation, particularly if they have pulmonary findings, are persistently bacteremic, especially with methicillin-resistant S aureus.