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Utility of Common Biomarkers for Diagnosing Infection in Nonunion.
J Orthop Trauma. 2020 Oct 21 [Online ahead of print]JO

Abstract

OBJECTIVES

To evaluate the diagnostic utility of leukocyte count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for distinguishing between septic and aseptic nonunions.

DESIGN

A single-gate (cohort) design was employed using one set of eligibility criteria applied to a consecutive sample of nonunions.

SETTING

Private quaternary referral center.

PATIENTS/PARTICIPANTS

Inclusion criteria were consecutive patients (>18 years) with a nonunion requiring surgery that allowed for direct or medullary canal tissue sampling from the nonunion site. The cohort included 204 subjects with 211 nonunions.

INTERVENTION

Blood samples were drawn for laboratory analysis of WBC, ESR, and CRP prior to surgery.

MAIN OUTCOME MEASUREMENTS

The reference standard used to define infection was the fracture-related infection confirmatory criteria. Measures of diagnostic accuracy were calculated. In order to assess the additional diagnostic gain of each index lab test while simultaneously considering the others, logistic regression models were fit.

RESULTS

The prevalence of infection was 19% (40 of 211 nonunion sites). The positive likelihood ratios (95% CI) for WBC, ESR, and CRP were 1.07 (0.38-3.02), 1.27 (0.88-1.82) and 1.57 (0.94-2.60), respectively. Multivariable modeling adjusted for the effect of preoperative antibiotics showed that WBC (p = 0.42), ESR (p = 0.48), and CRP (p = 0.23) were not significant predictors of infection.

CONCLUSIONS

In this consecutive sample of 211 nonunions in whom standard clinical practice would be to obtain index lab tests, our findings showed that WBC, ESR, and CRP were not significant predictors of infection.

LEVEL OF EVIDENCE

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Authors+Show Affiliations

Fondren Orthopedic Research Institute, Houston, TX. Fondren Orthopedic Group, Houston, TX. Texas Orthopedic Hospital, Houston, TX.Fondren Orthopedic Group, Houston, TX. Texas Orthopedic Hospital, Houston, TX.Fondren Orthopedic Research Institute, Houston, TX.Fondren Orthopedic Research Institute, Houston, TX.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33105452

Citation

Brinker, Mark R., et al. "Utility of Common Biomarkers for Diagnosing Infection in Nonunion." Journal of Orthopaedic Trauma, 2020.
Brinker MR, Macek J, Laughlin M, et al. Utility of Common Biomarkers for Diagnosing Infection in Nonunion. J Orthop Trauma. 2020.
Brinker, M. R., Macek, J., Laughlin, M., & Dunn, W. R. (2020). Utility of Common Biomarkers for Diagnosing Infection in Nonunion. Journal of Orthopaedic Trauma. https://doi.org/10.1097/BOT.0000000000001925
Brinker MR, et al. Utility of Common Biomarkers for Diagnosing Infection in Nonunion. J Orthop Trauma. 2020 Oct 21; PubMed PMID: 33105452.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of Common Biomarkers for Diagnosing Infection in Nonunion. AU - Brinker,Mark R, AU - Macek,Jenny, AU - Laughlin,Mitzi, AU - Dunn,Warren R, Y1 - 2020/10/21/ PY - 2020/10/26/entrez PY - 2020/10/27/pubmed PY - 2020/10/27/medline JF - Journal of orthopaedic trauma JO - J Orthop Trauma N2 - OBJECTIVES: To evaluate the diagnostic utility of leukocyte count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for distinguishing between septic and aseptic nonunions. DESIGN: A single-gate (cohort) design was employed using one set of eligibility criteria applied to a consecutive sample of nonunions. SETTING: Private quaternary referral center. PATIENTS/PARTICIPANTS: Inclusion criteria were consecutive patients (>18 years) with a nonunion requiring surgery that allowed for direct or medullary canal tissue sampling from the nonunion site. The cohort included 204 subjects with 211 nonunions. INTERVENTION: Blood samples were drawn for laboratory analysis of WBC, ESR, and CRP prior to surgery. MAIN OUTCOME MEASUREMENTS: The reference standard used to define infection was the fracture-related infection confirmatory criteria. Measures of diagnostic accuracy were calculated. In order to assess the additional diagnostic gain of each index lab test while simultaneously considering the others, logistic regression models were fit. RESULTS: The prevalence of infection was 19% (40 of 211 nonunion sites). The positive likelihood ratios (95% CI) for WBC, ESR, and CRP were 1.07 (0.38-3.02), 1.27 (0.88-1.82) and 1.57 (0.94-2.60), respectively. Multivariable modeling adjusted for the effect of preoperative antibiotics showed that WBC (p = 0.42), ESR (p = 0.48), and CRP (p = 0.23) were not significant predictors of infection. CONCLUSIONS: In this consecutive sample of 211 nonunions in whom standard clinical practice would be to obtain index lab tests, our findings showed that WBC, ESR, and CRP were not significant predictors of infection. LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence. SN - 1531-2291 UR - https://www.unboundmedicine.com/medline/citation/33105452/Utility_of_Common_Biomarkers_for_Diagnosing_Infection_in_Nonunion L2 - https://doi.org/10.1097/BOT.0000000000001925 DB - PRIME DP - Unbound Medicine ER -
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