6337 Diagnosing bone and joint infection in young children: to scan or not to scan?

Résumé fourni par la source

Objectives In addition to clinical decision aids like the Kocher and Caird criteria, imaging such as ultrasound or MRI is increasingly used in the workup of children presenting with suspected bone and joint infections. Especially in younger children, MRI often requires sedation or a general anaesthetic, while ultrasound is more readily available. Our aim was to see whether including imaging in the diagnostic process may potentially lead to a delay in starting definitive treatment and to assess the impact of the imaging modality. Methods Retrospective data analysis of patients with a diagnosis of septic arthritis and/or osteomyelitis in a tertiary paediatric centre using the electronic patient record system EPIC, admitted between 2015 and 2023. Patients were ranked according to age on presentation and the youngest 100 were included in this study. Data on the timing and findings of imaging was collected and paired with the time to definitive treatment which was either surgery and/or antibiotics. Results The average age of patients in this cohort was 4.2 years, ranging from 13 days to 14 years, 48% of children were aged less than 2 years. 27% of patients had an ultrasound scan of which 74% were abnormal. 65% of patients had a MRI scan prior to any therapeutic intervention, all of which were abnormal. The mean time from presentation to ultrasound was 13.3 hours (median 10.5) and 38.42 hours (median 25.75) for MRI. Figure 1 shows the time elapsed for patients with ultrasound scan only compared to MRI from first attendance to start of definitive treatment. In 79% of patients this was a surgical intervention in addition to antibiotic Conclusion Availability of MRI in young children is often delayed due to a need for sedation/general anaesthetic. It may not be required in all cases in order to confirm diagnosis and to start definitive treatment. Ultrasound seems to shorten the time to treatment compared to MRI. A decision to treat based on a combination of clinical decision aids and ultrasound may lead to definitive treatment and diagnostic tests. Prospective analysis of data to define which young children benefit from which modality of scanning in addition to clinical decision aids is required.

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