Investigating the Correlations Among Clinical, Laboratory, and Imaging Findings in Pediatric Patients with Osteomyelitis and Septic Arthritis: A 12- Year Retrospective Study

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 comorbidity, 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 : SA and OM were predominantly observed in boys aged 2–12 years. Comorbidities and immunosuppressive medications were associated with increased disease severity. Fever was recorded in less than 80% of the patients. The ESR emerged as the only parameter significantly associated with culture results, highlighting its importance in assessing infection severity and patient follow-up. The relationship between ultrasound findings and SA severity can guide clinical management. These findings identified MRI as the gold standard for diagnosing OM. The low culture positivity rates underscore the need for timely empirical treatment initiation, even in the absence of positive culture results.