Abstract：
Acute hematogenous musculoskeletal infections are a common cause of hospitalization in children. A locally developed clinical care guideline (CCG) for acute musculoskeletal infections was implemented at our quaternary care pediatric hospital in July 2012. The purpose of this study was to evaluate the long-term sustainability of previously described improvements after CCG implementation.
Clinical outcomes for children hospitalized with musculoskeletal infections at Children\'s Hospital Colorado from June 2009 through September 2018 were retrospectively reviewed. Patients were included if they had an International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision discharge diagnosis of acute osteomyelitis, septic arthritis, or pyomyositis and were between 6 months and 18 years of age at admission. Patients with underlying medical complexity or nonhematogenous musculoskeletal infections were excluded. Patients were categorized by date of admission as either \"pre-CCG\" (June 2009 to June 2011) or \"sustain-CCG\" (July 2014 to September 2018). Primary outcomes were hospital length of stay and intravenous antimicrobial length of therapy.
From pre-CCG to sustain-CCG, median length of stay decreased by 1.29 days (5.56 vs 4.27; P < .004) and median length of therapy decreased by 5.04 days (8.33 vs 3.29; P < .0001). Statistical process control charts support that these were sustained improvements many years after CCG implementation. Additional secondary clinical improvements were observed in the sustain-CCG group including faster fever resolution, more consistent blood and source culture acquisition, and decreased central line placement. There was no increase in related readmissions or therapeutic failures in the sustain-CCG group.
Implementation of a CCG to standardize care for musculoskeletal infections can be sustained many years after implementation.
Clinical outcomes for children hospitalized with musculoskeletal infections at Children\'s Hospital Colorado from June 2009 through September 2018 were retrospectively reviewed. Patients were included if they had an International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision discharge diagnosis of acute osteomyelitis, septic arthritis, or pyomyositis and were between 6 months and 18 years of age at admission. Patients with underlying medical complexity or nonhematogenous musculoskeletal infections were excluded. Patients were categorized by date of admission as either \"pre-CCG\" (June 2009 to June 2011) or \"sustain-CCG\" (July 2014 to September 2018). Primary outcomes were hospital length of stay and intravenous antimicrobial length of therapy.
From pre-CCG to sustain-CCG, median length of stay decreased by 1.29 days (5.56 vs 4.27; P < .004) and median length of therapy decreased by 5.04 days (8.33 vs 3.29; P < .0001). Statistical process control charts support that these were sustained improvements many years after CCG implementation. Additional secondary clinical improvements were observed in the sustain-CCG group including faster fever resolution, more consistent blood and source culture acquisition, and decreased central line placement. There was no increase in related readmissions or therapeutic failures in the sustain-CCG group.
Implementation of a CCG to standardize care for musculoskeletal infections can be sustained many years after implementation.
摘要：
急性血源性肌肉骨骼感染是儿童住院的常见原因。2012年7月，我们的四级护理儿科医院实施了针对急性肌肉骨骼感染的本地开发的临床护理指南（CCG）。这项研究的目的是评估CCG实施后先前描述的改进的长期可持续性。
回顾性分析了2009年6月至2018年9月在科罗拉多州儿童医院住院的肌肉骨骼感染儿童的临床结果。如果患者有国际疾病分类，第九次修订或国际疾病分类，第10次修订出院诊断急性骨髓炎，化脓性关节炎,或化脓性肌炎，入院时年龄在6个月至18岁之间。排除具有潜在医学复杂性或非血源性肌肉骨骼感染的患者。患者按入院日期分为“前CCG”（2009年6月至2011年6月）或“持续CCG”（2014年7月至2018年9月）。主要结果为住院时间和静脉抗菌药物治疗时间。
从pre-CCG到sustain-CCG，中位住院时间减少1.29天(5.56vs4.27;P<.004),中位治疗时间减少5.04天(8.33vs3.29;P<.0001).统计过程控制图支持这些是CCG实施多年后的持续改进。在持续CCG组中观察到额外的次要临床改善，包括更快的发烧消退，更一致的血液和来源培养获得，中心线位置减少。维持CCG组的相关再入院或治疗失败没有增加。
实施CCG以标准化肌肉骨骼感染的护理可以在实施后持续多年。
回顾性分析了2009年6月至2018年9月在科罗拉多州儿童医院住院的肌肉骨骼感染儿童的临床结果。如果患者有国际疾病分类，第九次修订或国际疾病分类，第10次修订出院诊断急性骨髓炎，化脓性关节炎,或化脓性肌炎，入院时年龄在6个月至18岁之间。排除具有潜在医学复杂性或非血源性肌肉骨骼感染的患者。患者按入院日期分为“前CCG”（2009年6月至2011年6月）或“持续CCG”（2014年7月至2018年9月）。主要结果为住院时间和静脉抗菌药物治疗时间。
从pre-CCG到sustain-CCG，中位住院时间减少1.29天(5.56vs4.27;P<.004),中位治疗时间减少5.04天(8.33vs3.29;P<.0001).统计过程控制图支持这些是CCG实施多年后的持续改进。在持续CCG组中观察到额外的次要临床改善，包括更快的发烧消退，更一致的血液和来源培养获得，中心线位置减少。维持CCG组的相关再入院或治疗失败没有增加。
实施CCG以标准化肌肉骨骼感染的护理可以在实施后持续多年。
