Serum Procalcitonin Shows Promise but Limited Sensitivity for Diagnosing Pediatric Osteomyelitis: Study

An elaborate computer-based search was undertaken for studies that considered PCT for the diagnosis of pediatric osteomyelitis. Accordingly, records were screened and selected according to PRISMA guidelines for systematic reviews and meta-analysis. Review Manager software 5.3, Meta-disc software 1.4, STATA 12.0, and R 3.4 software were used for statistical analyses.

Key Findings

• A total of five studies were included in the analysis, encompassing 148 children diagnosed with osteomyelitis who were tested for bacterial cultures in PCT.

• The diagnostic meta-analysis revealed a pooled sensitivity of 0.58 (95% confidence interval [CI]: 0.49 to 0.68) and a pooled specificity of 0.92 (95% CI: 0.90 to 0.93) for PCT in diagnosing pediatric osteomyelitis.

• The area under the curve (AUC) for PCT in the diagnosis of osteomyelitis in children was 0.80, indicating a good level of diagnostic accuracy.

• The Deeks’ regression test for asymmetry showed no publication bias (P = 0.90).

The results indicate that the sensitivity of PCT is relatively low against high specificity, which suggests it is good at correctly excluding those without the disease but less good at picking up most of those with the disease. This therefore raises the potential utility of PCT as a part of a larger diagnostic strategy rather than as a standalone test for pediatric osteomyelitis.

This is a comprehensive literature review for the application of PCT in diagnosing pediatric osteomyelitis. Although PCT may represent an interesting biomarker, low sensitivity indicates that the use of the marker by itself is not plausible; therefore, it would have to be combined with other diagnostic tools. Further studies in bigger populations are needed to prove the accuracy of PCT for this indication.

Reference:

Qi, H., Zhu, D., Wang, X., & Wu, J. (2024). Meta-analysis of the accuracy of the serum procalcitonin diagnostic test for osteomyelitis in children. BMC Musculoskeletal Disorders, 25(1). https://doi.org/10.1186/s12891-024-07716-3