Venous thrombosis and thromboembolism in children with osteomyelitis

Objective: To determine the prevalence and clinical features of deep vein thrombosis (DVT) complicating osteomyelitis during childhood. Study design: We retrospectively reviewed medical records of all patients with osteomyelitis admitted to Children's Medical Center Dallas between July 1, 2003 and December 31, 2004. Analysis was performed on patients with proximal upper or lower extremity, pelvic or vertebral osteomyelitis (a subgroup considered to be at highest risk for infection-related thrombosis). Results: Thirty-five patients had confirmed osteomyelitis of the proximal humerus, proximal tibia/fibula, femur, pelvis, or vertebrae. Ten of these 35 children (29%) developed DVT during the acute infection based on imaging studies performed. Eight thrombi occurred adjacent to the infection and two occurred in relation to central venous catheters. Six of the 10 children with DVT also had evidence of infection disseminated to lung, brain, or heart, compared with only 1 of 25 patients without DVT (P = .001). Hospitalization was longer in those with DVT than without (33.5 v. 14.2 days, P = .001). Conclusion: Thromboembolic complications can occur in the setting of osteomyelitis, and affected patients may be at higher risk of disseminated infection.