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Defining the volume of consultations for musculoskeletal infection encountered by pediatric orthopaedic services in the United States.


ABSTRACT: OBJECTIVE:Adequate resources are required to rapidly diagnose and treat pediatric musculoskeletal infection (MSKI). The workload MSKI consults contribute to pediatric orthopaedic services is unknown as prior epidemiologic studies are variable and negative work-ups are not included in national discharge databases. The hypothesis was tested that MSKI consults constitute a substantial volume of total consultations for pediatric orthopaedic services across the United States. STUDY DESIGN:Eighteen institutions from the Children's ORthopaedic Trauma and Infection Consortium for Evidence-based Study (CORTICES) group retrospectively reviewed a minimum of 1 year of hospital data, reporting the total number of surgeons, total consultations, and MSKI-related consultations. Consultations were classified by the location of consultation (emergency department or inpatient). Culture positivity rate and pathogens were also reported. RESULTS:87,449 total orthopaedic consultations and 7,814 MSKI-related consultations performed by 229 pediatric orthopaedic surgeons were reviewed. There was an average of 13 orthopaedic surgeons per site each performing an average of 154 consultations per year. On average, 9% of consultations were MSKI related and 37% of these consults yielded positive cultures. Finally, a weak inverse monotonic relationship was noted between percent culture positivity and percent of total orthopedic consults for MSKI. CONCLUSION:At large, academic pediatric tertiary care centers, pediatric orthopaedic services consult on an average of ~3,000 'rule-out' MSKI cases annually. These patients account for nearly 1 in 10 orthopaedic consultations, of which 1 in 3 are culture positive. Considering that 2 in 3 consultations were culture negative, estimating resources required for pediatric orthopaedic consult services to work up and treat children based on culture positive administrative discharge data underestimates clinical need. Finally, ascertainment bias must be considered when comparing differences in culture rates from different institution's pediatric orthopaedics services, given the variability in when orthopaedic physicians become involved in a MSKI workup.

SUBMITTER: Koehler RJ 

PROVIDER: S-EPMC7272072 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Defining the volume of consultations for musculoskeletal infection encountered by pediatric orthopaedic services in the United States.

Koehler Ryan J RJ   Shore Benjamin J BJ   Hedequest Daniel D   Heyworth Benton E BE   May Colin C   Miller Patricia E PE   Rademacher Emily S ES   Sanborn Ryan M RM   Murphy Joshua S JS   Roseman Alyssa A   Stoneback Jason W JW   Trizno Anastasiya A AA   Goldstein Rachel Y RY   Harris Liam L   Nielsen Ena E   Talwar Divya D   Denning Jaime R JR   Saaed Noor N   Kutz Brooke B   Laine Jennifer C JC   Naas Mary M   Truong Walter H WH   Rotando Matthew M   Spence David D DD   Brighton Brian K BK   Churchill Christine C   Janicki Joseph A JA   King Kiana K   Wild Jacob J   Beebe Allan C AC   Crouse Schon S   Rough Teaya T   Rowan Mallory M   Singh Satbir S   Davis-Juarez Amanda A   Gould Adam A   Hughes Olivia O   Rickert Kathleen D KD   Upasani Vidyadhar V VV   Blumberg Todd J TJ   Bompadre Viviana V   Lindberg Antoinette W AW   Miller Mark L ML   Hill Jaclyn F JF   Peoples Hayley H   Rosenfeld Scott B SB   Turner Rod R   Copley Lawson A LA   Lindsay Eduardo A EA   Ramo Brandon A BA   Tareen Naureen N   Winberly R. Lane RL   Li G. Ying GY   Sessel Jordyn J   Johnson Megan E ME   Johnson Samuel S   Moore-Lotridge Stephanie N SN   Shelton Julie J   Baldwin Keith D KD   Schoenecker Jonathan G JG  

PloS one 20200604 6


<h4>Objective</h4>Adequate resources are required to rapidly diagnose and treat pediatric musculoskeletal infection (MSKI). The workload MSKI consults contribute to pediatric orthopaedic services is unknown as prior epidemiologic studies are variable and negative work-ups are not included in national discharge databases. The hypothesis was tested that MSKI consults constitute a substantial volume of total consultations for pediatric orthopaedic services across the United States.<h4>Study design<  ...[more]

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