Osteomyelitis guidelines push pediatric care

By Lynda Williams, Senior medwireNews Reporter

US clinicians have demonstrated the benefits of multidisciplinary evidence-based guidelines for the treatment of children with osteomyelitis.

In their study, published in TheJournal of Bone and Joint Surgery, the group observed significant improvements in the care and short-term outcomes of 61 patients treated in 2009 under the guidelines compared with those of 210 patients treated between 2002 and 2004, before implementation.

The children treated after introduction of the guidelines had a significantly shorter time to magnetic resonance imaging after admission than earlier patients (1.0 vs 2.5 days) and were more likely to receive clindamycin as their first antibiotic (85.2 vs 12.9%). They also had fewer antibiotic changes (1.4 vs 2.0), and a longer duration of oral antibiotic treatment (43.7 vs 27.7 days).

In addition, guideline-treated patients were more likely to undergo a blood culture before antibiotic prescription than earlier patients (91.8 vs 79.5%), to have tissue from the infection site cultured (78.7 vs 62.9%), and to have their infectious agent determined by culturing (73.8 vs 60.0%).

This resulted in a significantly shorter duration of hospital stay for children treated under the guidelines compared with earlier patients (9.7 vs 12.8 days) and a significantly reduced need for readmission (6.6 vs 11.4%), report Lawson Copley (Children's Medical Center of Dallas, Texas, USA) and co-authors.

"The implementation of evidence-based, clinical practice guidelines by a multidisciplinary team had substantial impact on the process and efficiency of care for children with osteomyelitis," the researchers comment.

They suggest that a "more expeditious workflow for MRI during the early course of hospitalization arguably led to earlier surgical intervention to allow for timely hospital discharge," although no difference in the requirement for surgery was found.

In an accompanying commentary, James Wright (University of Toronto, Ontario, Canada) says that the clinical evidence used to develop the guidelines was weak in the absence of randomized controlled trials.

He agrees that the guideline was "effective" and "probably improved patient outcome and should be implemented more broadly," on the basis it improved work-up and organism identification.

"What is lacking, however, is important clinical outcomes such as complete eradication of the infection, return to school or play, lower disability, and better quality of life," he concludes.

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