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White blood cell count
2%
69/3916
MRI
1%
25/3916
Erythrocyte sedimentation rate
3%
100/3916
C-reactive protein
94%
3680/3916
Radiographs
20/3916
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The presence of an abscess in the setting of acute hematogenous osteomyelitis (AHO) is an indication for biopsy, culture, and open debridement. Appropriate treatment of osteomyelitis should lead to a rapid decline in the CRP, which peaks two days post-operatively, then begins to decline and normalizes within a week. Imaging studies will take much longer to show resolution of bone infection. Unkila-Kallio et al performed a study to compare the clinical value of the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count in diagnosis and follow-up of acute hematogenous osteomyelitis in children. They found that CRP increased and especially decreased significantly faster than ESR, reflecting the effectiveness of the therapy given and predicting recovery more sensitively than ESR or WBC count. Dormans et al reviewed acute hematogenous osteomyelitis (AHO) and subacute osteomyelitis, including Brodie's abscess, subacute epiphyseal osteomyelitis, and chronic recurrent multifocal osteomyelitis. They recommended various imaging modalities and ultimately biopsy to clarify the diagnosis. The goals of treatment were defined as (1) identification of the organism, (2) proper antibiotic selection, (3) adequate delivery of antibiotics and (4) arrest of tissue destruction.
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