Children hospitalized with acute hematogenous musculoskeletal infections (MSKIs) have a slight risk of experiencing venous thromboembolic events (VTEs), according to study results. However, the prevalence of this outcome was reportedly low. The researchers performing the study identified methicillin-resistant Staphylococcus aureas (MRSA) infections or critical illness among risk factors for VTE in this population. Study results were reported in the Journal of Pediatric Orthopaedics.

“The prevalence of clinically significant VTE among children with acute hematogenous MSKIs is low (2.1%); however, several easily recognized risk factors identify MSKI patients at the highest risk for VTE,” the researchers wrote in their report.

This single-center, retrospective cohort study included pediatric patients with an age between 6 months and 18 years. Patients included in the analysis were hospitalized from June 2009 through September 2018 and were diagnosed with acute osteomyelitis, septic arthritis, and/or pyomyositis. The researchers evaluated data on demographic and clinical characteristics for these patients in comparisons between those who experienced VTE and those who did not.

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There were 335 patients evaluated in the study, among whom VTE was identified in 7, for a rate of 2.1%. In their analyses, the researchers found that factors including age, sex, obesity rates, and several others did not appear linked to whether or not patients experienced VTE.

However, a multivariable analysis revealed that the presence of a MRSA infection was associated with an adjusted odds ratio (OR) for developing VTE of 31.7 (95% CI, 4.7-213.5; P <.001). Additionally, intensive care unit admission or transfer were associated with an adjusted OR for VTE of 26.4 (95% CI, 3.9-180; P <.001) in multivariable analysis.

In analyses of clinical characteristics, the researchers also found various differences in clinical characteristics in patients with VTEs, compared with patients without VTEs. For example, patients with VTEs had a longer median hospital length of stay (12.8 days) than patients without VTEs did (4.7 days; P <.001).

Patients with VTEs also had longer courses of intravenous antimicrobial therapy (median 13.5 days) than were seen in those without VTEs (median 3.7 days; P =.001), and a longer time to fever resolution (median 25.7 hours, compared with 162 hours without VTE; P =.004).

“Among children with MSKIs, those with MRSA infection and those needing critical care support were most likely to develop a VTE,” the researchers stated in their report. “Providers should have a low threshold to evaluate thromboses in such patients.”


Purtell SR, Thornhill D, Loi M, et al. Risk factors for venous thromboembolic events in children with acute musculoskeletal infections. J Pediatr Orthop. Published online March 16, 2023. doi:10.1097/BPO.0000000000002398