Clinical score for nonbacterial osteitis in children and adults

Annette F. Jansson, Thomas H. Müller, Leonhard Gliera, Donna Pauler Ankerst, U. Wintergerst, Bernd H. Belohradsky, Volkmar Jansson

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

Objective. To accurately differentiate nonbacterial osteitis (NBO) from other bone lesions by applying a clinical score through the use of validated diagnostic criteria. Methods. A retrospective study was conducted to assess data on patients from a pediatric clinic and an orthopedic tertiary care clinic, using administrative International Classification of Diseases codes as well as laboratory and department records from 1996 to 2006. Two hundred twenty-four patients older than age 3 years who had either NBO (n = 102), proven bacterial osteomyelitis (n = 22), malignant bone tumors (n = 48), or benign bone tumors (n = 52) were identified by chart review. Univariate logistic regression was used to determine associations of single risk factors with a diagnosis of NBO, and multivariable logistic regression was used to assess simultaneous risk factor associations with NBO. Results. NBO was best predicted by a normal blood cell count (odds ratio [OR] 81.5), symmetric bone lesions (OR 30.0), lesions with marginal sclerosis (OR 26.8), normal body temperature (OR 20.3) a vertebral, clavicular, or sternal location of lesions (OR 13.9), presence of >1 radiologically proven lesion (OR 10.9), and C-reactive protein level ≥1 mg/d1 (OR 6.9). The clinical score for a diagnosis of NBO based on these predictors ranged from 0 to 63. A score for NBO of ≥39 had a positive predictive value of 97% and a sensitivity of 68%. Conclusion. The proposed scoring system helps to facilitate the diagnostic process in patients with suspected NBO. Use of this system might spare unnecessary invasive diagnostic and therapeutic procedures.

Original languageEnglish (US)
Pages (from-to)1152-1159
Number of pages8
JournalArthritis and rheumatism
Volume60
Issue number4
DOIs
StatePublished - Apr 2009

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)

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    Jansson, A. F., Müller, T. H., Gliera, L., Ankerst, D. P., Wintergerst, U., Belohradsky, B. H., & Jansson, V. (2009). Clinical score for nonbacterial osteitis in children and adults. Arthritis and rheumatism, 60(4), 1152-1159. https://doi.org/10.1002/art.24402