Routine radiographic monitoring is not necessary for pediatric osteoarticular infections
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A routine radiographic protocol rarely alters the management of pediatric osteoarticular infections and significantly increases radiation exposure, health care utilization and costs, according to a speaker.
“The purpose of our study was to determine the utility of routine serial radiographs following acute treatment of musculoskeletal infections in the pediatric population and to recommend optimal radiographic follow-up protocols,” Rachel Mednick Thompson, MD, said in her presentation at the Pediatric Orthopaedic Society of North America Annual Meeting.
Thompson and colleagues analyzed 269 routine (n = 242) and reactive (n = 27) radiographs from 130 patients (mean age of 11.9 years) who were diagnosed and treated for isolated osteomyelitis (OM). Negative sequelae were defined as growth arrest or disturbance, pathologic fracture, recurrent infection and underlying neoplastic process, according to Thompson. Researchers also used number needed to screen (NNS), which was defined as the inverse of the incidence of negative sequelae detected.
Of the 242 routine radiographs, negative sequelae were detected in 1% (n = 3) with a resultant NNS of 81. Comparatively, of the 27 reactive radiographs, negative sequelae were detected in 11% (n = 3) with a resultant NNS of nine.
“Routine monitoring identified one leg length discrepancy and one pathologic fracture, both of which did present with concerning clinical findings which would have prompted reactive radiographs anyway,” Thompson said. “Reactive monitoring did identify mid-diaphyseal Ewing sarcoma and a recurrent distal tibial OM.”
“In conclusion, routine radiographs rarely detected negative sequelae specifically in the absence of any clinical concerning finding. Routine radiographs did increase radiation exposure, health care utilization and costs,” she added. “So, we recommend moving from a routine toward a reactive radiographic protocol following acute treatment of musculoskeletal infections in our population.”
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Thompson RM, et al. Paper 9. Presented at: Pediatric Orthopaedic Society of North America Annual Meeting; May 12-15, 2021; Dallas (hybrid meeting).
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