December 9, 2025Open Access

Investigating the correlations among clinical, laboratory, and imaging findings in pediatric patients with osteomyelitis and septic arthritis: a 12-year retrospective study

ABAmirali BarkhordarioonTehran University of Medical Sciences MTMahdieh Mousavi TorshiziIran University of Medical Sciences GSGhazal ShariatpanahiTehran University of Medical Sciences

Key Points

This research aims to identify correlations between clinical, laboratory, and imaging findings in pediatric patients with osteomyelitis and septic arthritis.
Retrospective analysis of 65 pediatric patients diagnosed with septic arthritis and osteomyelitis.
Analysis of clinical, laboratory, and imaging data, focusing on hospitalization duration and comorbidities.
Assessment of key laboratory markers such as leukocytosis and C-Reactive Protein levels.
69.2% of patients were male with a mean age of 5.4 years for septic arthritis and 4.8 years for osteomyelitis.
Elevated C-Reactive Protein detected in 80.4% of septic arthritis patients and 68.4% for osteomyelitis.
Staphylococcus aureus was isolated in 75% of positive cultures, indicating it is a common pathogen in these conditions.

Abstract

Abstract Background Septic arthritis (SA) and Osteomyelitis (OM) are critical pediatric emergencies that can lead to severe complications, including mortality. The study aimed to investigate the relationships between risk factors and clinical, laboratory, and imaging findings in these diseases. Methods A retrospective study was conducted on 65 pediatric patients (46 diagnosed with SA and 19 with OM). Relevant demographic data, clinical, laboratory and imaging findings were analyzed. Results 45 (69.2%) patients were male. The mean age was 5.4 years for SA and 4.8 years for OM. The mean duration of hospitalization was 8.1 days for SA and 15.32 days for OM. Eight patients (12.3%) experienced specified comorbidities, leading to longer hospitalization. The most affected joints were the knee, hip, and ankle, whereas the most affected bones were the femur, tibia, and humerus. The main clinical symptoms and signs of OM included pain, tenderness, and fever, whereas those of SA included pain, limited mobility, and tenderness. Leukocytosis was observed in 57.9% of OM patients and 50% of SA patients. Erythrocyte Sedimentation Rate (ESR) elevation was found in 52.6% of OM patients and 54.3% of SA patients. Elevated C-Reactive Protein (CRP) was present in 68.4% of OM and 80.4% of SA patients. Blood cultures were positive in 23.1% of OM patients and synovial fluid cultures in 23.5% of SA patients, with Staphylococcus aureus being the most common organism isolated (75%). There was a correlation between hospitalization duration for SA patients and abnormal ultrasound or X-ray findings. Conclusions Septic arthritis (SA) and osteomyelitis (OM) were more prevalent among boys aged 2–12 years. The presence of comorbidities and use of immunosuppressive medications were associated with prolonged hospital stays. Notably, fever was present in fewer than 80% of patients. Among laboratory markers, ESR was the only parameter significantly correlated with both positive culture results and longer hospitalization, emphasizing its utility in assessing infection severity and guiding follow-up. Ultrasound findings were helpful in evaluating SA severity and informing clinical management. MRI emerged as the gold standard for diagnosing OM. Finally, the low rate of culture positivity highlights the importance of initiating timely empirical antibiotic therapy, even in the absence of confirmed microbiological evidence.

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