A Rapid MRI Protocol for Acute Pediatric Musculoskeletal Infection Eliminates Contrast, Decreases Sedation, Scan and Interpretation Time, Hospital Length of Stay, and Charges

Chen, K; McBride, Daniel J.; Wild, Jacob; Kwon, Soyang; Samet, Jonathan D.; Gibly, Romie F.

doi:10.55275/jposna-2023-731

Cited by 6 publications

(8 citation statements)

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“…2, orange line). This is a unique problem for countries where pediatric healthcare depends on a personal insurance plan 13,22 .…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen publications were identified that met criteria by introducing a clinical care innovation and reporting its impact on LOS 12,13,[29][30][31][32][33][34][35][36][37][38][39][40][41][42] (Table III). Studies that only explored the efficacy of shorter antibiotic treatment have not been included as this is previously established information.…”

Section: Clinical Care Innovations To Streamline Inpatient Care and R...mentioning

confidence: 99%

“…Earlier studies often cite protocols whereby children underwent sedation during MRI and immediate progression to theater after imaging could be reviewed by the surgical team. 13,34 . Shorter time from admission to imaging was also a goal for these studies.…”

Section: Imaging Protocolmentioning

confidence: 99%

“…Recent research gives thought to obtaining imaging in a streamlined fashion, with the goal of improving surgical planning and recognizing disseminated disease early. Protocols for quick transition from the emergency department to the scanner, and then to the operating room, suggest that lengthy hospitalization might be avoided with efficient diagnosis and treatment 13 .…”

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confidence: 99%

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Methods to Reduce Cost of Treatment in Childhood Bone and Joint Infection

Hunter,

Crawford,

et al. 2024

JBJS Reviews

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Background: Childhood bone and joint infection (BJI) is a potentially severe disease with consequences for growth and development. Critically unwell children may require prolonged hospitalization and multiple surgeries. Acknowledging rising healthcare costs and the financial impact of illness on caregivers, increased efforts are required to optimize treatment. This systematic review aims to characterize existing costs of hospital care and summarize strategies, which reduce treatment expense. Methods: A systematic review of the literature was performed from January 1, 1980, to January 31, 2024. Data were extracted on hospitalization costs for pediatric BJI by decade and global region. Results have been converted to cost per day in US dollars with purchase parity for 2023. Studies reporting innovations in clinical care to reduce length of stay (LOS) and simplify treatment were identified. Studies trialing shorter antibiotic treatment were only included if they specifically reported changes in LOS. Results: Twenty-three studies met inclusion criteria; of these, a daily hospitalization cost could be derived from 7 publications. Overall hospitalization cost and inpatient charges rose steeply from the 1990s to the 2020s. By contrast, average LOS seems to have decreased. Cost per day was higher in the United States than in Europe and higher for cases with confirmed methicillin-resistant Staphylococcus aureus. Sixteen studies report innovations to optimize care. For studies where reduced LOS was achieved, early magnetic resonance imaging with immediate transfer to theater when necessary and discharge on oral antibiotics were consistent features. Conclusion: Rising costs of hospital care and economic consequences for families can be mitigated by simplifying treatment for childhood BJI. Hospitals that adopt protocols for early advanced imaging and oral antibiotic switch may provide satisfactory clinical outcomes at lower cost. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…2, orange line). This is a unique problem for countries where pediatric healthcare depends on a personal insurance plan 13,22 .…”

Section: Resultsmentioning

confidence: 99%

Section: Clinical Care Innovations To Streamline Inpatient Care and R...mentioning

confidence: 99%

Section: Imaging Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

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Methods to Reduce Cost of Treatment in Childhood Bone and Joint Infection

Hunter,

Crawford,

et al. 2024

JBJS Reviews

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“…Likewise, it would be beneficial to develop new tools to decrease the time to obtain preoperative MRI. Several academic centers are developing rapid MRI sequence protocols that show promise in decreasing the need for anesthesia and time to surgery [ 25 ]. Our data suggest that patient outcomes are not adversely affected by obtaining preoperative MRI despite the delay in time to OR.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Patients with Osteomyelitis and/or Septic Joint Undergoing Surgical Debridement Have Equivalent Short-Term Outcomes with or without Preoperative MRI

Englert,

Braithwaite,

Aguirre-Flores

et al. 2024

Children

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The purpose of this study was to determine if short-term outcomes differed for pediatric patients with suspected musculoskeletal infection with or without a preoperative MRI. This was a multicenter, retrospective review of patients aged 0–16 years who presented with atraumatic extremity pain, underwent irrigation and debridement (I&D), and received at least one preoperative or postoperative MRI over a 10-year period. Primary outcomes were time to OR, total I&Ds, readmission rate, time from OR to discharge, and total number of MRIs. Secondary outcomes entailed the rate at which concurrent osteomyelitis was identified in patients with septic arthritis and the extent of the resulting surgical debridement. Of the 104 patients, 72.1% had a preoperative MRI. Patients with a preoperative MRI were significantly less likely to have surgery on the day of admission. No difference was found between groups regarding total I&Ds, readmission rate, time from OR to discharge, and total number of MRIs. Of the 57 patients diagnosed with septic arthritis, those with a preoperative MRI were significantly more likely to have concurrent osteomyelitis identified and to undergo bony debridement in addition to arthrotomy of the joint. In conclusion, patient outcomes are not adversely affected by obtaining a preoperative MRI despite the delay in time to OR. Although preoperative MRI can be beneficial in ruling out other pathologies and identifying the extent of concurrent osteomyelitis, the decision to obtain a preoperative MRI and timing of surgery should be left to the discretion of the treating surgeon.

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