Early Magnetic Resonance Imaging Use in Clinical Care Pathways for Musculoskeletal Infections in Pediatric Patients: A Systematic Review

Abstract

ABSTRACT: Background: Magnetic resonance imaging (MRI) is often used in the work-up for pediatric patients with musculoskeletal infections (MSKIs). The timing of MRI has been shown to impact surgical accuracy and clinical outcomes for MSKI patients. However, its use in clinical care pathways (CCPs) for suspected cases of MSKI in this population has not been thoroughly reviewed. The objective of this literature review is to determine whether the use of MRI in CCPs for suspected cases of MSKI improves clinical outcomes. Methods: A review was systematically conducted by 2 authors using studies from Ovid Embase, Ovid Medline, Scopus, Web of Science, and Google Scholar. Studies were screened for relevancy and inclusion criteria through the Covidence database. Retrospective cohort studies that discussed the use of MRI for MSKI in exclusively pediatric populations, published since 1990, and were written/translated to English were included. The quality of the included studies was assessed using tools for cohort studies from Cochrane and the National Center for Biotechnology Information. A qualitative summary of the results was used due to the small number of studies and variables reported in the included studies. A secondary search and review were conducted by the same 2 authors to identify more studies after the initial review. Results: The first search across 5 databases yielded 1,857 studies. Of these, 3 retrospective cohort studies were relevant to the topic of the review and met the inclusion criteria. The second search yielded 120 studies, but none were applicable for inclusion. The 3 included studies showed that early MRI improves diagnostic accuracy and surgical timing. They reported on the ability of MRI to define the full extent of an MSKI and identify adjacent infections preoperatively, which improves surgical outcomes and decreases complication rates. The studies reported that early MRI use in CCPs decreases reoperation rates and unnecessary surgeries. The authors also discussed how early MRI use can indirectly decrease hospital costs. Conclusions: Early use of MRI in suspected cases of MSKIs may allow for an accurate and timely diagnosis and may lead to early intervention and a decreased rate of complications. MRI can depict the full extent of infection and any adjacent infection(s), allowing for the correct intervention to be selected. This may decrease the number of unnecessary surgeries, thereby reducing reoperation rates, length of stay, and readmission rates. Key Concepts: (1) Magnetic resonance imaging (MRI) is a diagnostic tool for musculoskeletal infections (MSKIs). (2) Prioritizing early MRI in clinical care pathways of suspected cases of MSKIs may improve patient outcomes. (3) Benefits of early MRI for MSKI patients may include reducing unnecessary surgeries and reoperation rates. Level of Evidence: II

Keywords

• Magnetic resonance imaging (MRI)
• Musculoskeletal infections (MSKI)
• Pediatric musculoskeletal infections
• Osteomyelitis
• Septic arthritis
• Diagnostic imaging