Keenan Marie, Hsu Marianna, Leveille Lise, Alvarez Christine, Simmonds Andrea
Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
J Pediatr Soc North Am. 2024 Jul 15;8:100096. doi: 10.1016/j.jposna.2024.100096. eCollection 2024 Aug.
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.
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.
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.
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.
(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.
II.
磁共振成像（MRI）常用于小儿肌肉骨骼感染（MSKI）患者的检查。已表明MRI检查的时机对MSKI患者的手术准确性和临床结局有影响。然而，其在该人群疑似MSKI病例的临床护理路径（CCP）中的应用尚未得到全面评估。本综述的目的是确定在CCP中对疑似MSKI病例使用MRI是否能改善临床结局。
由2位作者系统检索Ovid Embase、Ovid Medline、Scopus、Web of Science和谷歌学术的研究。通过Covidence数据库筛选研究的相关性和纳入标准。纳入1990年以来发表的、专门针对小儿人群讨论MRI用于MSKI的回顾性队列研究，且研究需为英文撰写或已翻译成英文。使用Cochrane和美国国立生物技术信息中心的队列研究工具评估纳入研究的质量。由于纳入研究报告的研究数量和变量较少，因此对结果进行定性总结。最初检索后，由相同的2位作者进行二次检索和综述以识别更多研究。
在5个数据库中首次检索得到1857项研究。其中，3项回顾性队列研究与综述主题相关且符合纳入标准。二次检索得到120项研究，但均不适合纳入。纳入的3项研究表明，早期MRI可提高诊断准确性和手术时机。这些研究报告了MRI界定MSKI完整范围以及术前识别相邻感染的能力，这可改善手术结局并降低并发症发生率。研究报告称，在CCP中早期使用MRI可降低再次手术率和不必要的手术。作者还讨论了早期使用MRI如何间接降低医院成本。
在疑似MSKI病例中早期使用MRI可实现准确及时的诊断，并可能导致早期干预和并发症发生率降低。MRI可描绘感染的完整范围以及任何相邻感染，从而选择正确的干预措施。这可能减少不必要的手术数量，从而降低再次手术率、住院时间和再入院率。
（1）磁共振成像（MRI）是肌肉骨骼感染（MSKI）的诊断工具。（2）在疑似MSKI病例的临床护理路径中优先进行早期MRI检查可能改善患者结局。（3）早期MRI对MSKI患者的益处可能包括减少不必要的手术和再次手术率。
II级
