Initial pre-referral workup

Clinical history

Any bone can be affected, but cancellous bone is more common such as the metaphyseal region of long bones.

Child is unwell with a fever, anorexia, localised tenderness or spasm around the joint if the infection is close to the joint.

Beware of subacute osteomyelitis, where there may be few constitutional signs.

Investigations

• FBE, ESR, CRP
• X-ray (change may lag 10 days behind clinical presentation)

GP management

Send to ED immediately if unwell and do not give antibiotics as it will negate cultures.

It may be reasonable to arrange some investigations if child not clearly unwell.

Refer parents to Osteomyelitis in children (fact sheet).

Indications for specialist referral

Emergency

If clinically suspected, send patient to ED.