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Pediatric Patients with Osteomyelitis and/or Septic Joint Undergoing Surgical Debridement Have Equivalent Short-Term
E Graham Englert1, Collin L Braithwaite2, Maria E Aguirre-Flores3
1Department of Orthopaedic Surgery, Beaumont Hospital Royal Oak, Royal Oak, MI 48073, USA.
Insights
Preoperative MRI for pediatric musculoskeletal infection did not worsen short-term outcomes, though it may delay surgery. This imaging can help identify concurrent osteomyelitis in septic arthritis cases.
Area of Science:
- Pediatric Orthopedics
- Musculoskeletal Infections
- Medical Imaging
Background:
- Musculoskeletal infections in children require prompt diagnosis and treatment.
- The role of preoperative magnetic resonance imaging (MRI) in managing suspected pediatric musculoskeletal infections remains debated.
- Preoperative MRI may influence surgical timing and diagnostic yield.
Purpose of the Study:
- To evaluate the impact of preoperative MRI on short-term outcomes in pediatric patients with suspected musculoskeletal infection.
- To compare outcomes between patients who received a preoperative MRI versus those who did not.
- To assess the diagnostic value of preoperative MRI for concurrent osteomyelitis in septic arthritis.
Main Methods:
- Multicenter, retrospective review of 104 pediatric patients (0-16 years) with atraumatic extremity pain.
- Inclusion criteria: irrigation and debridement (I&D) and at least one preoperative or postoperative MRI.
- Outcomes analyzed: time to operating room (OR), total I&Ds, readmission rate, time from OR to discharge, total MRIs, and identification of concurrent osteomyelitis.
Main Results:
- 72.1% of patients had a preoperative MRI, which was associated with a significant delay in time to OR.
- No significant differences were observed in total I&Ds, readmission rates, or length of hospital stay between groups.
- Preoperative MRI significantly increased the likelihood of identifying concurrent osteomyelitis and the need for bony debridement in septic arthritis cases.
Conclusions:
- Preoperative MRI in pediatric musculoskeletal infections does not adversely affect short-term patient outcomes despite potential delays in surgical intervention.
- MRI is valuable for identifying concurrent osteomyelitis and guiding surgical debridement in septic arthritis.
- The decision to obtain a preoperative MRI and the timing of surgery should be individualized by the treating surgeon.
Abstract:
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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