Clinical Utility of Repeat Magnetic Resonance Imaging Studies Among Children With Acute Hematogenous Osteomyelitis
Abby Thorne1, Angela Moss2, Julia S Sanders3
1University of Colorado School of Medicine.
Background And Objectives:
There is limited guidance for whether repeat magnetic resonance imaging (MRI) studies are clinically impactful among children with acute hematogenous osteomyelitis (AHO) who fail to improve as expected. This study aimed to determine whether repeat MRIs changed management among children with AHO and identify clinical characteristics predictive of which patients benefit from repeat MRIs.
Methods:
Children admitted to a quaternary care pediatric hospital with AHO were identified during a 9-year period. Patients with chronic symptoms, non-hematogenous infections, or significant contributing comorbidities were excluded. Medical records were retrospectively reviewed for all MRIs performed 3 weeks before admission to 24 months after discharge. An MRI was considered clinically impactful if it identified a new infectious process (eg, abscess not seen on the initial MRI) or if it resulted in surgical intervention within 24 hours. Bivariable comparisons of categorical variables were performed, and multivariable logistic regression was used to assess the clinical factors of impactful repeat MRIs.
Results:
Among the 239 included patients, 41 (17%) had more than 1 MRI performed during their clinical course, the majority of whom (53.7%) had a repeat MRI that impacted care. Patients who underwent repeat MRIs had longer hospitalizations (7 vs. 5 d, P <0.01), were more likely to have C-reactive protein (CRP) levels >20 mg/dL (41% vs. 10%, P <0.01), and were more likely to have a delayed transition to oral antimicrobials (8.4 vs. 3.3 d, P <0.01). Peak CRP >20 mg/dL and prolonged bacteremia were found to be associated with increased odds of having an impactful repeat MRI, with adjusted odds ratios of 3.9 ( P =0.007) and 3.4 ( P =0.03), respectively.
Conclusions:
When used judiciously among ill children with complicated AHO, repeat MRI can be clinically impactful. Prospective studies are needed to better define which children with AHO benefit from repeat MRI.
Level Of Evidence:
Level II evidence-this is a retrospective cohort study interested in determining the clinical utility of repeat magnetic resonance imaging studies for children with osteomyelitis.
Insights
Repeat MRI scans can be clinically impactful for children with acute hematogenous osteomyelitis (AHO) who are not improving. Higher C-reactive protein levels and prolonged bacteremia predict when repeat MRIs significantly alter patient management.
Area of Science:
- Pediatric Radiology
- Pediatric Infectious Diseases
- Musculoskeletal Imaging
Background:
- Limited guidance exists on the clinical impact of repeat magnetic resonance imaging (MRI) in children with acute hematogenous osteomyelitis (AHO) who show suboptimal response to treatment.
- Understanding the utility of repeat imaging is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To determine if repeat MRI studies changed management in pediatric patients with AHO.
- To identify clinical characteristics that predict which children with AHO benefit from repeat MRI scans.
Main Methods:
- Retrospective cohort study of children diagnosed with AHO at a quaternary pediatric hospital over 9 years.
- Analysis included MRI scans performed from 3 weeks before admission to 24 months post-discharge.
- Clinical impact defined by new infectious processes or surgical intervention within 24 hours; multivariable logistic regression identified predictive factors.
Main Results:
- Of 239 patients, 41 (17%) had repeat MRIs, with 53.7% of these impacting care.
- Patients with repeat MRIs had longer hospitalizations and were more likely to have elevated C-reactive protein (CRP) levels (>20 mg/dL) and delayed oral antibiotic transition.
- Peak CRP >20 mg/dL (aOR 3.9) and prolonged bacteremia (aOR 3.4) were associated with impactful repeat MRIs.
Conclusions:
- Judicious use of repeat MRI can be clinically impactful in children with complicated AHO.
- Further prospective studies are needed to refine criteria for selecting children with AHO who would benefit most from repeat MRI.
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