Research Award Details

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Regional Variations in pediatric Musculoskeletal Infection

Grant Recipient: Jonathan Schoenecker, MD, PhD

Co-Investigators: Megan Mignemi, MD
Institution:
Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital
Presentations & Publications:
Presentations:
  1. 2018 POSNA annual meeting – Received Best Poster – “Defining the Volume of Musculoskeletal Infections Evaluated by Pediatric Orthopaedic Providers in the United States”
  2. American Academy of Pediatrics (AAP) National Conference & Exhibition section of Orthopedics Annual Meeting – “Defining the Volume of Musculoskeletal Infections Evaluated by Pediatric Orthopaedic Providers in the United States”
 
Publications:
  1. PLOS ONE https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234055
Further Funding:
  • Texas Children’s Start up Grant (Rosenfeld PI). RO3 was submitted and reviewed. Resubmission in process.
  • Pending NIH submission

 

Additional Information:

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.

Conclusions: 
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.