Defining the volume of consultations for musculoskeletal infection encountered by pediatric orthopaedic services in the United States

Abstract

Adequate resources are required to rapidly diagnose and treat pediatric musculoskeletal infection (MSKI). The workload MSKI consults contribute to pediatric orthopaedic services is unknown as prior epidemiologic studies are variable and negative work-ups are not included in national discharge databases. The hypothesis was tested that MSKI consults constitute a substantial volume of total consultations for pediatric orthopaedic services across the United States. Study design Eighteen institutions from the Children's ORthopaedic Trauma and Infection Consortium for Evidence-based Study (CORTICES) group retrospectively reviewed a minimum of 1 year of hospital data, reporting the total number of surgeons, total consultations, and MSKI-related consultations. Consultations were classified by the location of consultation (emergency department or inpatient). Culture positivity rate and pathogens were also reported. Results 87,449 total orthopaedic consultations and 7,814 MSKI-related consultations performed by 229 pediatric orthopaedic surgeons were reviewed. There was an average of 13 orthopaedic surgeons per site each performing an average of 154 consultations per year. On average, 9% of consultations were MSKI related and 37% of these consults yielded positive cultures. Finally, a weak inverse monotonic relationship was noted between percent culture positivity and percent of total orthopedic consults for MSKI.

Characteristics of Children With Culture Negative Acute Hematogenous Musculoskeletal Infections

“…22 Following implementation of this clinical pathway, our institution has the highest rate of pathogen identification for pediatric MSKIs described with 75% to 79% of acute MSKIs having a bacterial cause identified as compared with the national average of 37%. 23 However, this means 20% to 25% of our MSKI patients still remain culture negative despite our best efforts to uncover a bacterial culprit. 3,15,16,19 Identifying distinguishing characteristics of patients with culture negative MSKIs might help explain this apparent limit to our diagnostic yield.…”

Descriptive Epidemiology of Upper Extremity Septic Arthritis in Children—Review of a Retrospective Multicenter Database

“…While there was only 1 case of MRSA in our shoulder septic arthritis group, MRSA was the most commonly identified organism on their intraoperative tissue cultures. Reasons for this likely include the older average age of the children in their study and the higher prevalence of MRSA musculoskeletal infections in the geographic region in which their study was performed 15…”

“…After Institutional Review Board approval and the completion of data use transfer agreements from each institution, a multicenter retrospective review of medical records was performed at 18 participating institutions to create a database of patients aged ≤18 years with musculoskeletal infection 15. The group consists of pediatric orthopaedic surgeon principal investigators at university-affiliated and stand-alone children’s hospital systems across the United States.…”

Comparison of Procalcitonin With Commonly Used Biomarkers and Algorithms for Evaluating Suspected Pediatric Musculoskeletal Infection in the Emergency Department

“…A multi-center study recently reported that 10 percent of pediatric orthopaedic consultations were for musculoskeletal infection and that culture-positive confirmation of infection occurred in only 37% of cases. 15 Accurate diagnosis of children with signs and symptoms of musculoskeletal infection is challenging due to the tremendous overlap of symptoms, physical findings, and inflammatory markers between infectious and noninfectious conditions. Daniel Kahneman recently explored the extent to which judgment under uncertainty, particularly predictive judgment, is subject to noise, bias, and objective ignorance in modern healthcare.…”