Clinical Care Guideline for Improving Pediatric Acute Musculoskeletal Infection Outcomes

Abstract Background Acute pediatric musculoskeletal infections are common, leading to significant use of resources and antimicrobial exposure. In order to decrease variability and improve the quality of care, Children’s Hospital Colorado implemented a clinical care guideline (CCG) for these infectio...

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Bibliographic Details
Published in:Journal of the Pediatric Infectious Diseases Society 2017-09, Vol.6 (3), p.e86-e93
Main Authors: Spruiell, Murray D, Searns, Justin Benjamin, Heare, Travis C, Roberts, Jesse L, Wylie, Erin, Pyle, Laura, Donaldson, Nathan, Stewart, Jaime R, Heizer, Heather, Reese, Jennifer, Scott, Halden F, Pearce, Kelly, Anderson, Colin J, Erickson, Mark, Parker, Sarah K
Format: Article
Language:English
Subjects:
Abscess - drug therapy
Acute Disease
Anti-Bacterial Agents - therapeutic use
Arthritis, Infectious - drug therapy
Central Venous Catheters - statistics & numerical data
Child
Child, Preschool
Drug Utilization
Drug Utilization Review - standards
Drug Utilization Review - statistics & numerical data
Female
Fever
Guideline Adherence - statistics & numerical data
Hospitals, Pediatric
Humans
Infections - drug therapy
Length of Stay - statistics & numerical data
Male
Medical Records
Musculoskeletal Diseases - diagnosis
Musculoskeletal Diseases - drug therapy
Osteomyelitis - drug therapy
Patient Readmission - standards
Patient Readmission - statistics & numerical data
Practice Guidelines as Topic
Pyomyositis - drug therapy
Quality of Health Care - standards
Quality of Health Care - statistics & numerical data
Retrospective Studies
Treatment Outcome
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Summary:Abstract Background Acute pediatric musculoskeletal infections are common, leading to significant use of resources and antimicrobial exposure. In order to decrease variability and improve the quality of care, Children’s Hospital Colorado implemented a clinical care guideline (CCG) for these infections. The purpose of this study is to evaluate clinical and resource outcomes PRE and POST this CCG. Methods Retrospective chart review evaluated patients admitted to a large pediatric quaternary referral center (CHCO) diagnosed with acute osteomyelitis, septic arthritis, pyomyositis, and/or musculoskeletal abscess prior to and after guideline implementation. Primary outcomes included length of stay and overall antibiotic use, with additional secondary clinical, process, and therapeutic outcomes examined. Results 82 patients were identified in both the pre-CCG and post-CCG cohorts. There was a reduction in the median of all primary outcomes, including length of stay (0.6 median days decrease, P = .04), length of IV antibiotic therapy (4.9 median days decrease, P < .0001), and days of IV antibiotic therapy (6.4 median days decrease, P = .0004). Our median length of stay post-CCG was 4.9 days, the shortest reported length of stay for pediatric acute musculoskeletal infections to date. Additionally, there was a 24.5 hour reduction in median length of fever (P = .02), faster CRP normalization (P < .0001), 50% decrease in the number of related readmissions (P = .02), 34% decrease in central venous catheters placed (P < .0001), decreased time to first culture (P = .02), and 79% pathogen identification post-CCG (P = .056). Conclusions Implementation of a CCG for acute musculoskeletal infections improves patient, process and resource outcomes.
ISSN:2048-7193
2048-7207
DOI:10.1093/jpids/pix014