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Musculoskeletal Sepsis in the Pediatric Intensive Care Unit.

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Children with severe bone and joint infections (BJI) requiring pediatric intensive care unit (PICU) admission had longer hospital stays and worse outcomes. Māori children were overrepresented in PICU admissions for BJI.

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Area of Science:

  • Pediatric Infectious Diseases
  • Critical Care Medicine
  • Health Services Research

Background:

  • Childhood bone and joint infections (BJI) can be severe, necessitating pediatric intensive care unit (PICU) admission.
  • Understanding factors associated with PICU admission and outcomes is crucial for managing severe BJI.

Purpose of the Study:

  • To describe demographic and prehospital features of BJI cases requiring PICU admission.
  • To report treatment outcomes and associated costs for children with severe BJI admitted to the PICU.

Main Methods:

  • Retrospective cohort study of children (≤15 years) hospitalized with acute hematogenous osteomyelitis or septic arthritis in Auckland (2018-2023).
  • Comparison of cases admitted to PICU versus those not requiring PICU admission.
  • Analysis of direct medical hospitalization costs, treatment, and outcomes up to 1 year post-discharge.

Main Results:

  • 8% (43/563) of BJI cases were admitted to PICU, with shorter prehospital symptom duration.
  • PICU cases experienced significantly longer hospitalizations (35.78 vs. 8.71 days) and higher readmission/complication rates.
  • Average hospitalization cost for PICU cases was $378,120 NZD, compared to $32,219 NZD for non-PICU cases.
  • Māori ethnicity, prior infections, and congenital conditions were associated with PICU admission.

Conclusions:

  • Children admitted to PICU for severe BJI often have a history of congenital conditions or previous infections.
  • Māori children are disproportionately represented among severe BJI cases requiring PICU.
  • PICU-treated children face longer hospitalizations and more adverse outcomes within a year of discharge.