1. Defining the volume of consultations for musculoskeletal infection encountered by pediatric orthopaedic services in the United States
- Author
-
Ena Nielsen, Ryan Sanborn, Mary Naas, Rachel Y. Goldstein, Divya Talwar, Jacob Wild, Olivia Hughes, Brandon A. Ramo, Jonathan G. Schoenecker, Daniel Hedequest, Scott Rosenfeld, Emily S Rademacher, Amanda Davis-Juarez, Noor Saaed, David D. Spence, Hayley Peoples, Mark L Miller, Kiana King, Jaclyn F. Hill, Vidyadhar V. Upasani, Julie Shelton, Anastasiya A Trizno, Samuel R Johnson, Jaime Rice Denning, Rod Turner, Alyssa Roseman, Stephanie N. Moore-Lotridge, Matthew Rotando, Todd J Blumberg, Jordyn Sessel, Allan Beebe, Kathleen D Rickert, Liam Harris, G. Ying Li, Patricia E. Miller, Children’s Orthopaedic Trauma, Ryan J Koehler, Joshua S. Murphy, Satbir Singh, Eduardo A Lindsay, R. Lane Winberly, Megan Johnson, Walter H. Truong, Jason W Stoneback, Lawson A B Copley, Adam Gould, Schon Crouse, Mallory Rowan, Brian K Brighton, Naureen Tareen, Colin May, Keith D. Baldwin, Brooke Kutz, Benjamin J. Shore, Antoinette W. Lindberg, Teaya Rough, Viviana Bompadre, Joseph A. Janicki, Benton E. Heyworth, Christine Churchill, Jennifer C. Laine, and Tse, Herman
- Subjects
Male ,Critical Care and Emergency Medicine ,Medical Doctors ,Health Care Providers ,Staphylococcus ,Orthopedic Surgery ,Children’s Orthopaedic Trauma and Infection Consortium for Evidence Based Study (CORTICES) Group ,Pathology and Laboratory Medicine ,Tertiary care ,Pediatrics ,0302 clinical medicine ,Medicine and Health Sciences ,Medicine ,Musculoskeletal Diseases ,Medical Personnel ,Child ,Referral and Consultation ,Pediatric ,030222 orthopedics ,Multidisciplinary ,Workload ,Medical microbiology ,Work-up ,Bacterial Pathogens ,Professions ,Female ,Methicillin-resistant Staphylococcus aureus ,Pathogens ,Pediatric Infections ,Research Article ,Pediatric Orthopedics ,medicine.medical_specialty ,Staphylococcus aureus ,General Science & Technology ,Science ,MEDLINE ,Surgical and Invasive Medical Procedures ,Musculoskeletal infection ,Infections ,Microbiology ,03 medical and health sciences ,Musculoskeletal System Procedures ,Clinical Research ,030225 pediatrics ,Physicians ,Humans ,Microbial Pathogens ,Retrospective Studies ,Surgeons ,Biology and life sciences ,Bacteria ,business.industry ,Organisms ,Correction ,Retrospective cohort study ,Emergency department ,United States ,Health Care ,Orthopedics ,Family medicine ,Orthopedic surgery ,People and Places ,Population Groupings ,business - 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.
- Published
- 2020