Submitting/Presenting Author

Emily Bonanni, Children's Mercy HospitalFollow

Presenter Status

Fellow

Abstract Type

Research

Primary Mentor

Dr. Kate Kyler

Start Date

5-5-2022 12:30 PM

End Date

5-5-2022 12:45 PM

Presentation Type

Oral Presentation

Description

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Background: Common pediatric musculoskeletal infections (MSKIs) require prompt recognition & treatment to prevent significant morbidity and mortality. Variation in initial workup of these infections & associations with clinical outcomes is not well studied and could aid development of evidence-based guidelines to provide high-value care for all MSKIs.

Objectives/Goal: Examine variation in initial lab testing & imaging obtained in patients hospitalized for common MSKIs and explore association with clinical outcomes (length of stay (LOS), cost, 30-day readmission).

Methods/Design: We performed a retrospective, multicenter cohort study of hospitalized children aged 6 months to 18 years with a diagnosis of acute osteomyelitis, septic arthritis or pyomyositis from 1/1/16 to 6/30/20 using the Pediatric Health Information System (PHIS) database. We collected rates of common lab testing (complete blood count [CBC], inflammatory marker [IM], blood culture) & radiographic studies (ultrasound [US], xray [XR], magnetic resonance imaging [MRI], computed tomography [CT] scan) obtained on hospital days 0 & 1. K-means clustering grouped hospitals based on frequency of which lab and imaging studies were obtained. Logistic regression was used to determine associations between overall cluster utilization & risk-adjusted patient outcomes.

Results: We identified 6597 children admitted from 44 hospitals with an included MSKI diagnosis. More than 50% were 2-10 years of age, with a majority being male (Table 1). Most children ( > 84%) had CBC or IM, with some variation across diagnoses. MRI and XR imaging were used most frequently (56 and 59%, respectively), also with variation across diagnoses (Table 1). Cluster 1 (n=15) showed slightly higher lab utilization and lower US use (Figure 1) with significantly shorter hospital LOS for patients with acute osteomyelitis (3.7 vs. 4.0 days, p-value 0.043; Table 2) but no significant difference in cost or readmission rates. There were no outcome differences for patients with septic arthritis or pyomyositis.

Conclusions: Despite a lack of universal practice guidelines in the work up & management of pediatric MSKIs, little variation existed in workup or outcomes across hospitals. This may be due to similar initial presentation of many MSKIs. Future investigation of differences in detailed patient-level clinical factors (e.g., lab results, vitals) on initial presentation or downstream hospital management could elucidate if associations with outcomes exist between different MSKIs.

MeSH Keywords

osteomyelitis; septic arthritis; pyomyositis

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May 5th, 12:30 PM May 5th, 12:45 PM

Variation in Laboratory & Radiographic Workup and Outcome in Children Hospitalized with Common Musculoskeletal Infections

Watch recording of live presentation.

Background: Common pediatric musculoskeletal infections (MSKIs) require prompt recognition & treatment to prevent significant morbidity and mortality. Variation in initial workup of these infections & associations with clinical outcomes is not well studied and could aid development of evidence-based guidelines to provide high-value care for all MSKIs.

Objectives/Goal: Examine variation in initial lab testing & imaging obtained in patients hospitalized for common MSKIs and explore association with clinical outcomes (length of stay (LOS), cost, 30-day readmission).

Methods/Design: We performed a retrospective, multicenter cohort study of hospitalized children aged 6 months to 18 years with a diagnosis of acute osteomyelitis, septic arthritis or pyomyositis from 1/1/16 to 6/30/20 using the Pediatric Health Information System (PHIS) database. We collected rates of common lab testing (complete blood count [CBC], inflammatory marker [IM], blood culture) & radiographic studies (ultrasound [US], xray [XR], magnetic resonance imaging [MRI], computed tomography [CT] scan) obtained on hospital days 0 & 1. K-means clustering grouped hospitals based on frequency of which lab and imaging studies were obtained. Logistic regression was used to determine associations between overall cluster utilization & risk-adjusted patient outcomes.

Results: We identified 6597 children admitted from 44 hospitals with an included MSKI diagnosis. More than 50% were 2-10 years of age, with a majority being male (Table 1). Most children ( > 84%) had CBC or IM, with some variation across diagnoses. MRI and XR imaging were used most frequently (56 and 59%, respectively), also with variation across diagnoses (Table 1). Cluster 1 (n=15) showed slightly higher lab utilization and lower US use (Figure 1) with significantly shorter hospital LOS for patients with acute osteomyelitis (3.7 vs. 4.0 days, p-value 0.043; Table 2) but no significant difference in cost or readmission rates. There were no outcome differences for patients with septic arthritis or pyomyositis.

Conclusions: Despite a lack of universal practice guidelines in the work up & management of pediatric MSKIs, little variation existed in workup or outcomes across hospitals. This may be due to similar initial presentation of many MSKIs. Future investigation of differences in detailed patient-level clinical factors (e.g., lab results, vitals) on initial presentation or downstream hospital management could elucidate if associations with outcomes exist between different MSKIs.