Clinical characteristics and risk factors for poor prognosis in children with complicated acute hematogenous osteomyelitis treated with vaccum sealing drainage.

Abstract

Background: This study aims to analyze the clinical characteristics of children with complicated acute hematogenous osteomyelitis treated with vacuum sealing drainage (VSD) in our institution, and to explore the risk factors for poor prognosis.

Methods: A retrospective analysis was performed on the medical records of patients diagnosed with acute hematogenous Osteomyelitis from December 2015 to December 2022. The demographic profiles, treatment procedures, examination results, and follow-up information of the patients were meticulously recorded. Patients were categorized into two groups based on the occurrence of treatment failure, deformity, limb length discrepancy, growth arrest, osteonecrosis, chronic osteomyelitis, pathological fracture, chondrolysis, and recurrence: good prognosis group and poor prognosis group. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors associated with adverse prognosis. The performance of the regression model was assessed using the area under the receiver operating characteristic (ROC) curve.

Results: A total of 150 patients who met the inclusion criteria were followed up for an average of 3.4 years (range: 1.0-7.0 years). There were 31 patients (21%) in the poor prognosis group. In all cases, after 7 days of continuous saline irrigation and 2 surgical debridement, 75% of the infections were completely controlled, and the local abscess disappeared in 86% of the patients. By regression analysis, leukocyte admission (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) [1.0-1.4]; P = 0.04), first postoperative C-reactive protein level (aOR 1.04; 95% (CI), [1.0-1.07], P = 0.034), time to diagnosis of osteomyelitis (aOR 1.3; 95% (CI), [1.1-1.6], P = 0.012), and days of fever with antibiotics (aOR 1.5; 95% (CI), [1.1-2.2], P = 0.024) were independent risk factors for poor outcomes. The four variables combined to construct an efficient prediction model, with an area under the curve (AUC) of 0.85.

Conclusion: The innovative application of vacuum sealing drainage technology in the management of complicated patients with substantially localized abscesses achieved significant efficacy, while one-third of children still had unfavorable outcomes. High-risk groups with recurrence and sequelae necessitate regular follow-up and even long-term orthopedic intervention.