0
Scientific Articles   |    
The Impact of Evidence-Based Clinical Practice Guidelines Applied by a Multidisciplinary Team for the Care of Children with Osteomyelitis
Lawson A.B. Copley, MD, MBA1; Major Alison Kinsler, MD2; Taylor Gheen, BBA1; Adam Shar, MD3; David Sun, BS4; Richard Browne, PhD5
1 Department of Orthopedics, Children’s Medical Center of Dallas, 1935 Medical District Drive, Dallas, TX 75235. E-mail address for L.A.B. Copley: Lawson.Copley@childrens.com
2 William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920
3 Department of Orthopaedic Surgery, Scott and White Healthcare, 2401 South 31st Street, Temple, TX 76508
4 University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX 75390
5 Texas Scottish Rite Hospital, 2222 Welborn Street, Dallas, TX 75219
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Investigation performed at the Department of Orthopedics, Children’s Medical Center of Dallas, Dallas, Texas

A commentary by James G. Wright, MD, MPH, FRCSC, is linked to the online version of this article at jbjs.org.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 17;95(8):686-693. doi: 10.2106/JBJS.L.00037
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: 

Care of children with osteomyelitis requires multidisciplinary collaboration. This study evaluates the impact of evidence-based guidelines for the treatment of pediatric osteomyelitis when utilized by a multidisciplinary team.

Methods: 

Guidelines for pediatric osteomyelitis were developed and were implemented by a multidisciplinary team comprised of individuals from several hospital services, including orthopaedics, pediatrics, infectious disease, nursing, and social work, who met daily to conduct rounds and make treatment decisions. With use of retrospective review and statistical analysis, we compared children with osteomyelitis who had been managed at our institution from 2002 to 2004 (prior to the implementation of the guidelines), referred to as Group I in this study, with those who were managed in 2009 according to the guidelines, referred to as Group II.

Results: 

Two hundred and ten children in Group I were compared with sixty-one children in Group II. No significant differences between the two cohorts were noted for age, sex, incidence of methicillin-resistant Staphylococcus aureus infection (18.1% in Group I compared with 26.2% in Group II), incidence of methicillin-sensitive Staphylococcus aureus infection (23.8% in Group I compared with 27.9% in Group II), bacteremia, or surgical procedures. Significant differences (p < 0.05) between cohorts were noted for each of the following: the delay in magnetic resonance imaging after admission (2.5 days in Group I compared with one day in Group II), the percentage of patients who had received clindamycin as the initial antibiotic (12.9% in Group I compared with 85.2% in Group II), the percentage of patients who had had a blood culture before antibiotic administration (79.5% in Group I compared with 91.8% in Group II), the percentage of patients who had had a culture of tissue from the infection site (62.9% in Group I compared with 78.7% in Group II), the percentage of patients in whom the infecting organism was identified on tissue or blood culture (60.0% in Group I compared with 73.8% in Group II), the number of antibiotic changes (2.0 changes in Group I compared with 1.4 changes in Group II), and the mean duration of oral antibiotic use (27.7 days in Group I compared with 43.7 days in Group II). When compared with Group I, Group II had clinically important trends of a shorter total length of hospital stay (12.8 days in Group I compared with 9.7 days in Group II; p = 0.054) and a lower hospital readmission rate (11.4% in Group I compared with 6.6% in Group II; p = 0.34).

Conclusions: 

Evidence-based treatment guidelines applied by a multidisciplinary team resulted in a more efficient diagnostic workup, a higher rate of identifying the causative organism, and improved adherence to initial antibiotic recommendations with fewer antibiotic changes during treatment. Additionally, there were trends toward lower hospital readmission rates and a shorter length of hospitalization.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Guidelines
    Feverish illness in children: assessment and initial management in children younger than 5 years. -National Collaborating Centre for Women's and Children's Health | 8/28/2009
    Results provided by:
    PubMed
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    03/17/2014
    CT - Orthopaedic Foundation
    04/02/2014
    LA - Louisiana State University Health Sciences Center-Shreveport
    05/03/2012
    CA - UCLA/OH Department of Orthopaedic Surgery
    04/02/2014
    WV - Charleston Area Medical Center