%0 Journal Article
%T Clinical Care Guideline for Improving Pediatric Acute Musculoskeletal Infection Outcomes.
%A Spruiell MD
%A Searns JB
%A Heare TC
%A Roberts JL
%A Wylie E
%A Pyle L
%A Donaldson N
%A Stewart JR
%A Heizer H
%A Reese J
%A Scott HF
%A Pearce K
%A Anderson CJ
%A Erickson M
%A Parker SK
%J J Pediatric Infect Dis Soc
%V 6
%N 3
%D Sep 2017 1
%M 28419275
%F 5.235
%R 10.1093/jpids/pix014
%X <B>UNASSIGNED: </B>Acute pediatric musculoskeletal infections are common, leading to significant use of resources and antimicrobial exposure. In order to decrease variability and improve the quality of care, Children's Hospital Colorado implemented a clinical care guideline (CCG) for these infections. The purpose of this study is to evaluate clinical and resource outcomes PRE and POST this CCG.<BR><B>UNASSIGNED: </B>Retrospective chart review evaluated patients admitted to a large pediatric quaternary referral center (CHCO) diagnosed with acute osteomyelitis, septic arthritis, pyomyositis, and/or musculoskeletal abscess prior to and after guideline implementation. Primary outcomes included length of stay and overall antibiotic use, with additional secondary clinical, process, and therapeutic outcomes examined.<BR><B>UNASSIGNED: </B>82 patients were identified in both the pre-CCG and post-CCG cohorts. There was a reduction in the median of all primary outcomes, including length of stay (0.6 median days decrease, P = .04), length of IV antibiotic therapy (4.9 median days decrease, P < .0001), and days of IV antibiotic therapy (6.4 median days decrease, P = .0004). Our median length of stay post-CCG was 4.9 days, the shortest reported length of stay for pediatric acute musculoskeletal infections to date. Additionally, there was a 24.5 hour reduction in median length of fever (P = .02), faster CRP normalization (P < .0001), 50% decrease in the number of related readmissions (P = .02), 34% decrease in central venous catheters placed (P < .0001), decreased time to first culture (P = .02), and 79% pathogen identification post-CCG (P = .056).<BR><B>UNASSIGNED: </B>Implementation of a CCG for acute musculoskeletal infections improves patient, process and resource outcomes.