Reliability of the Beit CURE classification for the management of chronic hematogenous osteomyelitis of the long bones in children
Chronic hematogenous osteomyelitis (CHOM) of long bones in children remains a major clinical challenge in low- and middle-income countries. The Beit CURE classification has been used to guide treatment, but its reliability across different centers and raters has not been established. Forty-four children with CHOM were evaluated using digital radiographs by 16 fellowship-trained pediatric orthopedic surgeons from five continents. All the raters were trained in Beit CURE classification and assessed each case twice, 4 weeks apart. Interobserver and intraobserver reliability were calculated using intraclass correlation coefficients (ICCs). The raters also predicted anticipated surgical management and the number of procedures needed. Interobserver reliability was fair overall (ICC: 0.467, 95% confidence interval: 0.36–0.59). Agreement was highest for types A and B4 (>80% consensus) and lowest for types B2, B3, and C (<25%). The reliability for growth plate involvement was moderate (ICC: 0.628) and was poor for site involvement (ICC: 0.269). Predictions regarding surgical planning were inconsistent, especially for B2, B3, and C lesions. The Beit CURE classification demonstrated only limited reproducibility among experienced pediatric orthopedic surgeons. While types A and B4 were reliably identified, other subtypes showed poor agreement, undermining clinical decision-making. Refinements – such as merging B2 and B3, providing clearer definitions of sclerosis and involucrum quality, and integrating clinical parameters – are needed before the Beit CURE classification system can serve as a reliable guide for treatment planning. Level of Evidence Level 2.
Authors
- Abhishek Bhasme
- Qaisur Rabbi (ORCID: https://orcid.org/0000-0001-5536-8636)
- Dimuthu Tennakoon
- Tim Nunn
- Dhiren Ganjwala
- Vidyasagar Chandankere (ORCID: https://orcid.org/0000-0003-4101-9413)
- Nirmal Raj Gopinathan (ORCID: https://orcid.org/0000-0003-0208-5653)
- Mohan V. Belthur (ORCID: https://orcid.org/0000-0001-5279-0591)
- Hitesh Shah
- A Horn (ORCID: https://orcid.org/0000-0002-4159-6520)
- Parmanand Gupta (ORCID: https://orcid.org/0000-0002-1851-5497)
- Anuj Shrestha (ORCID: https://orcid.org/0000-0002-3502-6572)
- James A. Fernandes
- Alejandro Baar
- Binoti Sheth
- Abhay Gahukamble (ORCID: https://orcid.org/0000-0002-1557-1848)
- Anil Agarwal
- Nikhil Challwar
- Quazi Alam
- Ashish Rande
Institutions
- Manipal Academy of Higher Education (IN)
- Christian Medical College, Vellore (IN)
- Universidad de Los Andes, Chile (CL)
- Bangladesh Medical University (BD)
- Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College (IN)
- Government Vellore Medical College (IN)
- Lady Ridgeway Hospital for Children (LK)
- Ahmedabad Civil Hospital (IN)
- Mediciti Institute of Medical Sciences (IN)
- Government Medical College and Hospital (IN)
- Sunshine Hospitals (IN)
- Government Medical College and Hospital (IN)
- Kanti Children's Hospital (NP)
- Deenanath Mangeshkar Hospital and Research Center (IN)
- Phoenix Children's Hospital (US)
- Centre for the Rehabilitation of the Paralysed (BD)
- Indian Numismatic, Historical and Cultural Research Foundation (IN)
- Chacha Nehru Bal Chikitsalaya (IN)
- Red Cross War Memorial Children's Hospital (ZA)
- Indira Gandhi Institute of Child Health (IN)
- Sheffield Children's Hospital (GB)
- Post Graduate Institute of Medical Education and Research (IN)
- Addis Ababa University (ET)
- Kasturba Medical College, Manipal (IN)
Publication Details
- Journal
- Journal of Pediatric Orthopaedics B
- Published
- 2026-06-29
- DOI
- https://doi.org/10.1097/bpb.0000000000001371
- Primary Topic
- Orthopedic Infections and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00