Abstract
ObjectiveAdequate 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 designEighteen 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.Results87,449 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.ConclusionAt large, academic pediatric tertiary care centers, pediatric orthopaedic services consult on an average of ~3,000 ‘rule-out’ MSKI cases annually. These patients account for nearly 1 in 10 orthopaedic consultations, of which 1 in 3 are culture positive. Considering that 2 in 3 consultations were culture negative, estimating resources required for pediatric orthopaedic consult services to work up and treat children based on culture positive administrative discharge data underestimates clinical need. Finally, ascertainment bias must be considered when comparing differences in culture rates from different institution’s pediatric orthopaedics services, given the variability in when orthopaedic physicians become involved in a MSKI workup.
Highlights
Children diagnosed with musculoskeletal infection (MSKI) are vulnerable to significant morbidity
Retrospective studies have been utilized to establish diagnostic tools and clinical practice guidelines (CPGs); yet, many of these studies are focused on a single diagnosis and/or represent data from a single institution
Clinical isolates detected were reported as Methicillin-sensitive Staphylococcus aureus (MSSA), Methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pyogenes, Kingella kingae, Borrelia burgdorferi (Lyme disease), or “other” for less commonly encountered pathogens such as Enterobacter cloacae, Haemophilus influenzae, Pseudomonas aeruginosa, etc
Summary
Children diagnosed with musculoskeletal infection (MSKI) are vulnerable to significant morbidity. To aid in the evaluation of children who are suspected to have MSKI, several retrospective studies have been conducted to estimate the volume of children who experience infection each year and evaluate clinical trends in the local epidemiology of disease [3,4,5,6,7,8,9,10,11] Many of these studies have been based on administrative data and discharge diagnoses the coding of which may underestimate the total efforts devoted to rule-out infections in children who present with similar symptoms, yet receive an alternative diagnosis. Given the variation in bacterial isolates and antibiotic resistance reported between institutions [5, 6, 11, 12], the generalizability of these guidelines to the broader pediatric or infectious disease community may be limited [13,14,15]
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