Background: The association of deep venous thrombosis and deep
musculoskeletal infection in children has been reported infrequently. The
purpose of the present study was to evaluate the characteristics of children
with osteomyelitis in whom deep venous thrombosis developed and to compare
them with those of children with osteomyelitis in whom deep venous thrombosis
did not develop.
Methods: A retrospective review of the records of children who were
managed at our institution because of a deep musculoskeletal infection between
January 2002 and December 2004 identified 212 children with osteomyelitis
involving the spine, pelvis, or extremities. Children in whom deep venous
thrombosis developed were compared with those in whom it did not develop with
respect to age, diagnosis, causative organism, duration of symptoms prior to
admission, laboratory values at the time of admission, surgical procedures,
and required length of hospitalization.
Results: Eleven children with osteomyelitis and deep venous
thrombosis were identified. The mean C-reactive protein level was 16.9 mg/dL
for the group of eleven patients with osteomyelitis in whom deep venous
thrombosis developed, compared with only 6.8 mg/dL for the group of 201
patients with osteomyelitis in whom deep venous thrombosis did not develop (p
= 0.0044). Staphylococcus aureus was the causative organism of
infection in all eleven children with deep venous thrombosis and in
ninety-three (46%) of the 201 children without deep venous thrombosis.
Methicillin-resistant strains of Staphylococcus aureus were
identified in eight of the eleven children with deep venous thrombosis and in
only forty-nine of the 201 children without deep venous thrombosis. The
children with osteomyelitis and deep venous thrombosis were older, had a
longer duration of hospitalization, had more admissions to the intensive care
unit, and required more surgical procedures than those with osteomyelitis but
without deep venous thrombosis.
Conclusions: Deep venous thrombosis in association with
musculoskeletal infection is more common in children over the age of eight
years who have osteomyelitis caused by methicillin-resistant
Staphylococcus aureus and who present with a C-reactive protein level
of >6 mg/dL. Diagnostic venous imaging studies should be performed to
assess for the presence of deep venous thrombosis in children with
osteomyelitis, especially those who have these risk factors.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.