**10. Evaluation recommendations**

Any child with deep musculoskeletal infection, particularly osteomyelitis caused by *Staphylococcus* aureus should be considered at risk for DVT. However, in light of the medical literature, a higher index of suspicion should be held for those children with severe clinical presentation, including: intensive care unit admission, markedly elevated inflammatory indices, lower extremity location of the musculoskeletal infection, need for repeated surgical debridement, and pulmonary involvement with infiltrates or septic pulmonary emboli. These children should undergo screening with non-invasive Doppler ultrasound evaluation of the extremities in the region of the musculoskeletal infection to look for DVT. If the ability to assess the PVL status of the organism is present within any institution, then this should be considered whenever *Staphylococcus aureus* is isolated from bone, joint, or muscle specimens. While stratification of the relative risk of DVT may increase the awareness of the treating physician of the child's potential for DVT, it is important not to overlook the rare cases of DVT that might occur in children who fall outside of this risk profile, such as those with upper extremity locations of infection, infection types other than osteomyelitis, causative organisms other than *Staphylococcus aureus*, or age under 4 years. Whenever the clinical suspicion of DVT exists, supplemental imaging should be considered.
