Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 1;105-B(7):815-820.
doi: 10.1302/0301-620X.105B7.BJJ-2022-1316.R1.

Consensus guidelines on the management of musculoskeletal infection affecting children in the UK

Piers D Mitchell  1 , Alwyn Abraham  2 , Clare Carpenter  3 , Philip D Henman  4 , Jason Mavrotas  5 , Janet McCaul  6 , Anish Sanghrajka  7 , Tim Theologis  8 ; BSCOS Paediatric Musculoskeletal Infection Consensus Group
Affiliations

Consensus guidelines on the management of musculoskeletal infection affecting children in the UK

Piers D Mitchell et al. Bone Joint J. .

Abstract

Aims: The aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with musculoskeletal infection (including septic arthritis, osteomyelitis, pyomyositis, tenosynovitis, fasciitis, and discitis). This consensus can then be used to ensure consistent, safe care for children in UK hospitals and those elsewhere with similar healthcare systems.

Methods: A Delphi approach was used to determine consensus in three core aspects of care: 1) assessment, investigation, and diagnosis; 2) treatment; and 3) service, pathways, and networks. A steering group of paediatric orthopaedic surgeons created statements which were then evaluated through a two-round Delphi survey sent to all members of the British Society for Children's Orthopaedic Surgery (BSCOS). Statements were only included ('consensus in') in the final agreed consensus if at least 75% of respondents scored the statement as critical for inclusion. Statements were discarded ('consensus out') if at least 75% of respondents scored them as not important for inclusion. Reporting these results followed the Appraisal Guidelines for Research and Evaluation.

Results: A total of 133 children's orthopaedic surgeons completed the first survey, and 109 the second. Out of 43 proposed statements included in the initial Delphi, 32 reached 'consensus in', 0 'consensus out', and 11 'no consensus'. These 11 statements were then reworded, amalgamated, or deleted before the second Delphi round of eight statements. All eight were accepted as 'consensus in', resulting in a total of 40 approved statements.

Conclusion: In the many aspects of medicine where relevant evidence is not available for clinicians to base their practice, a Delphi consensus can provide a strong body of opinion that acts as a benchmark for good quality clinical care. We would recommend clinicians managing children with musculoskeletal infection follow the guidance in the consensus statements in this article, to ensure care in all medical settings is consistent and safe.

PubMed Disclaimer

Conflict of interest statement

T. Theologis is a past President of the British Society for Children’s Orthopaedic Surgery (BSCOS).

References

    1. Copley LAB , Barton T , Garcia C , et al. A proposed scoring system for assessment of severity of illness in pediatric acute hematogenous osteomyelitis using objective clinical and laboratory findings . Pediatr Infect Dis J . 2014 ; 33 ( 1 ): 35 – 41 . 10.1097/INF.0000000000000002 , 24352188
    1. Moore-Lotridge SN , Gibson BHY , Duvernay MT , et al. Pediatric musculoskeletal infection – an update through the four pillars of clinical care and Immunothrombotic similarities with COVID-19 . JPOSNA . 2020 ; 2 : 1 – 34 . 10.55275/JPOSNA-2020-124
    1. Mitchell PD , Viswanath A , Obi N , Littlewood A , Latimer M . A prospective study of screening for musculoskeletal pathology in the child with A limp or pseudoparalysis using erythrocyte sedimentation rate, C-reactive protein and MRI . J Child Orthop . 2018 ; 12 ( 4 ): 398 – 405 . 10.1302/1863-2548.12.180004 , 30154932
    1. Zaripova LN , Midgley A , Christmas SE , Beresford MW , Baildam EM , Oldershaw RA . Juvenile idiopathic arthritis: from aetiopathogenesis to therapeutic approaches . Pediatr Rheumatol Online J . 2021 ; 19 ( 1 ): 135 . 10.1186/s12969-021-00629-8 , 34425842
    1. Autore G , Bernardi L , Esposito S . Update on acute bone and joint infections in paediatrics: A narrative review on the most recent evidence-based recommendations and appropriate antinfective therapy . Antibiotics (Basel) . 2020 ; 9 ( 8 ): 486 . 10.3390/antibiotics9080486 , 32781552