Background: Under-diagnosis of pediatric osteoarticular infections at initial presentation leads to serious sequelae. Current clinical pathways should be examined to improve patient care. Osteoarticular infections can be classified into categories dependent on presence of a septic joint or associated abscess (simple or complex). A third group is identified; complex with systemic inflammatory response syndrome (SIRS). These patients are clinically unstable and require intensive care. These patients should be considered separately from those that are stable. Methods: Retrospective chart review was conducted for various clinical parameters. Patients were classified into groups depending on MRI and clinical findings. Only infections requiring surgery were included. These fell into two categories: (1) complex clinically stable (non-SIRS) and (2) complex clinically unstable (SIRS). Results: Time from symptom presentation to the first medical contact averaged 3.5 days. Time from symptom onset to Emergency Department presentation averaged 5.6 days. Average number of medical contacts before diagnosis was 3.5. Time from onset of symptoms to operating room was 6.7 days. Average time from MRI to surgery averaged 14.4 hours. Hospital length of stay was 5.2 days for the clinically stable group and 11.3 days for the ICU-care group. Conclusion: Children with progressive osteoarticular pain should be considered for an infection with a low threshold for obtaining labs and an MRI. The goal is to halt progression of infection, complications, and need for hospitalization. Delay in diagnosis did not cause progression to SIRS in all patients. Further studies are needed to assess delayed diagnosis and progression of complex infections.

Complex clinically unstable group

Complex clinically unstable group

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