Taking part

Osteomyelitis is a bacterial infection of bone. In children, it is typically introduced through the blood (haematogenous). Acute osteomyelitis presents with symptoms of less than two weeks, including pain, loss of limb function, raised temperature and malaise. The burden is significant, with approximately 1800 children admitted yearly to hospitals in England. Untreated OM rapidly progresses to irreversible joint damage and bone destruction, leading to a limb threatening situation, while systemic sepsis can be life threatening. Early differentiation of OM from less urgent conditions mimicking the symptoms is critical.

Patients typically present to the Emergency Department. After initial work-up (history, clinical examination, routine blood tests and radiographs), diagnosis is often uncertain and advanced imaging is considered: ultrasound scan (USS) and magnetic resonance imaging (MRI). USS is more accessible but the overall diagnostic value is unknown. MRI has high diagnostic value in adult OM but often requires anaesthesia in children. Understanding the sensitivity and specificity of diagnostic imaging, along with a clear decision tool that includes all diagnostic parameters, would be of great value. Relevant studies show this is a priority from both the clinicians’ and patients/families’ perspectives.