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Hypothesis: The purpose of this study was to determine the utility of inflammatory markers in diagnosis and treatment of hand and wrist infections in the pediatric and adolescent population. It was hypothesized that there is a difference of inflammatory marker levels between superficial and deep hand/wrist infections at presentation and throughout the course of treatment.

Methods: This is a multicenter, retrospective cohort study included patients age 0-18 who received treatment for an acute hand or wrist infection between 2009 - 2020. Sites included Children’s Hospital Colorado and Children’s Mercy Hospital. Data collected included demographics, diagnosis, inflammatory markers, culture results, antibiotic treatment, and surgical treatment. Infections were categorized as Deep (Osteomyelitis, Tenosynovitis, Abscess) and Superficial (Paronychia, Felon, Cellulitis). Exclusion criteria included: patients >18 y/o, chronic infection, open fractures, absence of inflammatory markers. Statistically, a t-test was used to compare inflammatory markers between deep and superficial infections. Patients who did and did not receive pre-treatment antibiotics were compared separately. Logistic regression models were used to evaluate the association of specific diagnoses with inflammatory markers and/or course of treatment.

Results: 129 patients met inclusion criteria. Deep hand infections (osteomyelitis, tendonitis, and abscesses) were significantly (p=0.0399) associated with a higher ESR (24.8; SD=25.7) than superficial infections (paronychia, felon, cellulitis) (14.5; SD=10.1). CRP and WBC were not significantly different between deep and superficial infections. No significant associations were found between lab markers and course of treatment (operative vs bedside vs oral antibiotics.) Pretreatment with antibiotics at an outside hospital prior to presentation for definitive management was not found to be significantly associated with changes in lab markers.

Conclusions: An elevated ESR is the inflammatory blood marker most predictive of a deep as opposed to superficial hand infections. Inflammatory markers were not significantly different between patients who received pre-treatment with antibiotics and those who did not. Clinicians may use ESR levels to evaluate severity of pediatric hand and wrist infections but should defer to clinical judgement for course of treatment.

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Establishing The Role Of Inflammatory Markers In The Diagnosis And Treatment Of Acute Hand Infections In The Pediatric Population