The Impact of Institutional Clinical Care Guidelines on Treatment Outcomes in Pediatric Musculoskeletal Infection: A Systematic Review

Abstract

Background: Pediatric musculoskeletal infections (MSKIs) are complicated to manage, and inconsistent approaches to care within an institution can negatively affect patient recovery. The aim of this systematic review is to assess the impact of implementing institutional clinical care guidelines (CCGs) on treatment outcomes in pediatric MSKIs.Methods: The authors carried out a systematic review of medical literature using the databases Embase and Medline. Ten comparative studies assessing quantitative treatment outcomes of pediatric patients with MSKIs before and after implementation of a CCG were included. Studies in adult populations and those lacking comparative analysis were excluded.Results: Implementing CCGs led to improvements in patient care and clinical outcomes. Outcomes assessed across papers varied. Implementation of CCGs for the management of pediatric patients with MSKIs was shown to shorten patients' length of stay, duration of IV and/or oral antibiotic therapy, and duration of clinical symptoms associated with MSKIs. There was also evidence of reduced financial costs, which was determined by cost-effective analysis in one study. Additionally, improved access to magnetic resonance imaging and better coordination between disciplines was discussed in some studies to benefit patients' outcomes by providing an earlier diagnosis and the ability to image concerns throughout treatment.Conclusions: CCGs for pediatric patients with MSKIs improve outcomes by decreasing length of stay and inpatient costs, promoting earlier transition from IV to oral antibiotics, decreasing central line use, encouraging coordination between disciplines, and prioritizing earlier access to MRI and surgery. Further research across existing literature regarding the impact of early access to MRI is of interest for the future.Level of Evidence: IIKey Concepts•Use of clinical care pathways to manage pediatric musculoskeletal infections improves patient outcomes.•Limiting unnecessary use of intravenous antibiotics in pediatric musculoskeletal infections decreases length of stay in hospital and central venous catheter use.•Clinical care pathways to manage pediatric musculoskeletal infections help decrease length of stay in hospital and overall hospital costs.•Implementing clinical care pathways to manage pediatric musculoskeletal infections can encourage earlier access to MRI.