title: How useful are laboratory investigations in the emergency department evaluation of possible osteomyelitis?
abstract: We conducted a literature review to determine which laboratory investigations are useful for the ED evaluation of osteomyelitis. Thirty-six relevant papers were identified. We concluded that in adult and paediatric patients with a clinically low level of suspicion of osteomyelitis, an age-adjusted normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) <5 mg/L should reassure the clinician that no further urgent investigation is required. For patients with risk factors for osteomyelitis or a clinically high level of suspicion, a normal ESR or CRP <5 mg/L should not rule out the diagnosis of osteomyelitis, especially in patients with puncture wounds or foot ulcers/infections. In patients with any suspicion of osteomyelitis and otherwise unexplained ESR >30 mm/h and/or CRP >10-30 mg/L further definitive investigation is required. The white blood count is not helpful in the evaluation of osteomyelitis.
authors.affiliation: Emergency Department, Timaru Public Hospital, Timaru, New Zealand. joeharrisnz@gmail.com
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Harris
authors.forename: Dave H
authors.initials: DH
authors.lastname: Caesar
authors.forename: Carol
authors.initials: C
authors.lastname: Davison
authors.forename: Rebecca
authors.initials: R
authors.lastname: Phibbs
authors.forename: Martin P
authors.initials: MP
authors.lastname: Than
mesh_terms: D000328:Adult; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D006801:Humans; D007958:Leukocyte Count; D010019:Osteomyelitis / Q000097:blood / Q000175:diagnosis*
chemical_list: D002097:C-Reactive Protein