Skip to main content
SpringerLink
Log in

Sensitivity of Erythrocyte Sedimentation Rate and C-reactive Protein in Childhood Bone and Joint Infections

  • Original Article
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

In addition to the examination of clinical signs, several laboratory markers have been measured for diagnostics and monitoring of pediatric septic bone and joint infections. Traditionally erythrocyte sedimentation rate (ESR) and leukocyte cell count have been used, whereas C-reactive protein (CRP) has gained in popularity. We monitored 265 children at ages 3 months to 15 years with culture-positive osteoarticular infections with a predetermined series of ESR, CRP, and leukocyte count measurements. On admission, ESR exceeded 20 mm/hour in 94% and CRP exceeded 20 mg/L in 95% of the cases, the mean (± standard error of the mean) being 51 ± 2 mm/hour and 87 ± 4 mg/L, respectively. ESR normalized in 24 days and CRP in 10 days. Elevated CRP gave a slightly better sensitivity in diagnostics than ESR, but best sensitivity was gained with the combined use of ESR and CRP (98%). Elevated ESR or CRP was seen in all cases during the first 3 days. Measuring ESR and CRP on admission can help the clinician rule out an acute osteoarticular infection. CRP normalizes faster than ESR, providing a clear advantage in monitoring recovery.

Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–C

Similar content being viewed by others

References

  1. Del Beccaro MA, Champoux AN, Bockers T, Mendelman PM. Septic arthritis versus transient synovitis of the hip: the value of screening laboratory tests. Ann Emerg Med. 1992;21:1418–1422.

    Article  CAS  PubMed  Google Scholar 

  2. Dich VQ, Nelson JD, Haltalin KC. Osteomyelitis in infants and children: a review of 163 cases. Am J Dis Child. 1975;129:1273–1278.

    CAS  PubMed  Google Scholar 

  3. Esposito S, Tremolati E, Begliatti E, Bosis S, Gualtieri L, Prinicipi N. Evaluation of a rapid bedside test for the quantitative determination of C-reactive protein. Clin Chem Lab Med. 2005;43:438–440.

    Article  CAS  PubMed  Google Scholar 

  4. Flood RG, Badik J, Aronoff SC. The utility of serum C-reactive protein in differentiating bacterial from nonbacterial pneumonia in children: a meta-analysis of 1230 children. Pediatr Infect Dis J. 2008;27:95–99.

    PubMed  Google Scholar 

  5. Gold R. Diagnosis of osteomyelitis. Pediatr Rev. 1991;12:292–297.

    Article  CAS  PubMed  Google Scholar 

  6. Kallio MJ, Unkila-Kallio L, Aalto K, Peltola H. Serum C-reactive protein, erythrocyte sedimentation rate and white blood cell count in septic arthritis in children. Pediatr Infect Dis J. 1997;16:411–413.

    Article  CAS  PubMed  Google Scholar 

  7. Kenney WE. The prognosis in acute hematogenous osteomyelitis with and without chemotherapy. Surgery. 1944;16:477–484.

    Google Scholar 

  8. Kunnamo I, Kallio P, Pelkonen P, Hovi T. Clinical signs and laboratory tests in the differential diagnosis of arthritis in children. Am J Dis Child. 1987;141:34–40.

    CAS  PubMed  Google Scholar 

  9. Kushner I, Broder ML, Karp D. Control of the acute phase response: serum C-reactive protein kinetics after acute myocardial infarction. J Clin Invest. 1978;61:235–242.

    Article  CAS  PubMed  Google Scholar 

  10. Levine MJ, McGuire KJ, McGowan KL, Flynn JM. Assessment of the test characteristics of C-reactive protein for septic arthritis in children. J Pediatr Orthop. 2003;23:373–377.

    Article  PubMed  Google Scholar 

  11. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Mélot C, Vincent JL. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest. 2003;123:2043–2049.

    Article  CAS  PubMed  Google Scholar 

  12. Lorrot M, Fitoussi F, Faye A, Mariani P, Job-Deslandre C, Penneçot GF, Bingen E, Bourrillon A. [Laboratory studies in pediatric bone and joint infections] [in French]. Arch Pediatr. 2007;14(suppl 2):S86–S90.

    Article  PubMed  Google Scholar 

  13. Malcius D, Barauskas V, Ukuraite R. Some aspects of long-term results of treatment of acute hematogenous osteomyelitis. Medicina (Kaunas). 2007;43:472–477.

    Google Scholar 

  14. Orimolade EA, Salawu L, Oginni LM. Clinical and laboratory features of Nigerian patients with osteomyelitis. Singapore Med J. 2007;48:917–921.

    CAS  PubMed  Google Scholar 

  15. Papaevangelou V, Papassotiriou I, Sakou I, Ferentinos G, Liapi G, Kyrka A, Konstantopoulos A. Evaluation of a quick test for C-reactive protein in a pediatric emergency department. Scand J Clin Lab Invest. 2006;66:717–722.

    Article  CAS  PubMed  Google Scholar 

  16. Peltola H. C-reactive protein in rapid differentiation of acute epiglottitis from spasmodic croup and acute laryngotracheitis: a preliminary report. J Pediatr. 1983;102:713–715.

    Article  CAS  PubMed  Google Scholar 

  17. Peltola H, Holmberg C. Rapidity of C-reactive protein in detecting potential septicemia. Pediatr Infect Dis. 1983;2:374–376.

    Article  CAS  PubMed  Google Scholar 

  18. Peltola H, Jaakkola M. C-reactive protein in early detection of bacteremic versus viral infections in immunocompetent and compromised children. J Pediatr. 1988;113:641–646.

    Article  CAS  PubMed  Google Scholar 

  19. Peltola H, Laipio ML, Siimes MA. Quantitative C-reactive protein (CRP) determined by an immunoturbidimetric method in rapid differential diagnosis of acute bacterial and viral diseases of children. Acta Paediatr Scand. 1984;73:273–274.

    Article  CAS  PubMed  Google Scholar 

  20. Peltola H, Räsänen JA. Quantitative C-reactive protein in relation to erythrocyte sedimentation rate, fever, and duration of antimicrobial therapy in bacteraemic diseases of childhood. J Infection. 1982;5:257–267.

    Article  Google Scholar 

  21. Pepys MB. C-reactive protein fifty years on. Lancet. 1981;1:653–657.

    Article  CAS  PubMed  Google Scholar 

  22. Roine I, Faingezicht I, Arguedas A, Herrera JF, Rodriguez F. Serial serum C-reactive protein to monitor recovery from acute hematogenous osteomyelitis in children. Pediatr Infect Dis J. 1995;14:40–44.

    CAS  PubMed  Google Scholar 

  23. Roine I, Ledermann W, Peltola H. C-reactive protein in hepatitis A. Acta Paediatr. 1992;81:631.

    Article  CAS  PubMed  Google Scholar 

  24. Scott RJ, Christofersen MR, Robertson WW Jr, Davidson RS, Rankin L, Drummond DS. Acute osteomyelitis in children: a review of 116 cases. J Pediatr Orthop. 1990;10:649–652.

    CAS  PubMed  Google Scholar 

  25. Seamark DA, Backhouse SN, Powell R. Field-testing and validation in a primary care setting of a point-of-care test for C-reactive protein. Ann Clin Biochem. 2003;40(Pt 2):178–180.

    Article  CAS  PubMed  Google Scholar 

  26. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39:206–217.

    Article  CAS  PubMed  Google Scholar 

  27. Tetzlaff TR, McCracken GH Jr, Nelson JD. Oral antibiotic therapy for skeletal infections of children: II. Therapy of osteomyelitis and suppurative arthritis. J Pediatr. 1978;92:485–490.

    Article  CAS  PubMed  Google Scholar 

  28. Unkila-Kallio L, Kallio MJ, Eskola J, Peltola H. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics. 1994;93:59–62.

    CAS  PubMed  Google Scholar 

  29. Unkila-Kallio L, Kallio MJ, Peltola H. The usefulness of C-reactive protein levels in the identification of concurrent septic arthritis in children who have acute hematogenous osteomyelitis: a comparison with the usefulness of the erythrocyte sedimentation rate and the white blood-cell count. J Bone Joint Surg Am. 1994;76:848–853.

    CAS  PubMed  Google Scholar 

  30. Wang CL, Wang SM, Yanq YJ, Tsai CH, Liu CC. Septic arthritis in children: relationship of causative pathogens, complications, and outcome. J Microbiol Immunol Infect. 2003;36:41–46.

    PubMed  Google Scholar 

  31. Wiley JJ, Fraser GA. Septic arthritis in childhood. Can J Surg. 1979;22:326–330.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the following physicians for their participation in the OM-SA Study Group: Kari Aalto, Aurora Hospital, and Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland; Ilkka Anttolainen, Päijät-Häme Central Hospital, Lahti, Finland; Marja Heikkinen, Kuopio University Hospital, Kuopio, Finland; Anita Hiippala, Etelä-Saimaa Central Hospital, Lappeenranta, Finland; Ulla Kaski, Seinäjoki Central Hospital, Seinäjoki, Finland; Niilo Kojo, Etelä-Saimaa Central Hospital, Lappeenranta, Finland; Pentti Lautala, Päijät-Häme Central Hospital, Lahti, Finland; Juhani Merikanto, Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland; Pekka Ojajärvi, Jorvi Hospital, Espoo, Finland; Eeva Salo, Aurora Hospital, and Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland.

Author information

Authors and Affiliations

  1. Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland

    Markus Pääkkönen MD, Markku J. T. Kallio MD, Pentti E. Kallio MD & Heikki Peltola MD

  2. Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland

    Markus Pääkkönen MD

Authors
  1. Markus Pääkkönen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Markku J. T. Kallio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pentti E. Kallio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heikki Peltola MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Markus Pääkkönen MD.

Additional information

This work was supported by Orion Pharma, through the University of Helsinki (Project Code 34490). Orion Pharma sells systems for monitoring C-reactive protein. The sponsor had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Helsinki University Central Hospital.

About this article

Cite this article

Pääkkönen, M., Kallio, M.J.T., Kallio, P.E. et al. Sensitivity of Erythrocyte Sedimentation Rate and C-reactive Protein in Childhood Bone and Joint Infections. Clin Orthop Relat Res 468, 861–866 (2010). https://doi.org/10.1007/s11999-009-0936-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-0936-1

Keywords

Search

Navigation