{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:29:25Z","timestamp":1792481365608,"version":"4.5.0"},"reference-count":13,"publisher":"American Academy of Pediatrics (AAP)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Acute hematogenous musculoskeletal infections are a common cause of hospitalization in children. A locally developed clinical care guideline (CCG) for acute musculoskeletal infections was implemented at our quaternary care pediatric hospital in July 2012. The purpose of this study was to evaluate the long-term sustainability of previously described improvements after CCG implementation.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n Clinical outcomes for children hospitalized with musculoskeletal infections at Children\u2019s Hospital Colorado from June 2009 through September 2018 were retrospectively reviewed. Patients were included if they had an International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision discharge diagnosis of acute osteomyelitis, septic arthritis, or pyomyositis and were between 6 months and 18 years of age at admission. Patients with underlying medical complexity or nonhematogenous musculoskeletal infections were excluded. Patients were categorized by date of admission as either \u201cpre-CCG\u201d (June 2009 to June 2011) or \u201csustain-CCG\u201d (July 2014 to September 2018). Primary outcomes were hospital length of stay and intravenous antimicrobial length of therapy.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n From pre-CCG to sustain-CCG, median length of stay decreased by 1.29 days (5.56 vs 4.27; P &lt; .004) and median length of therapy decreased by 5.04 days (8.33 vs 3.29; P &lt; .0001). Statistical process control charts support that these were sustained improvements many years after CCG implementation. Additional secondary clinical improvements were observed in the sustain-CCG group including faster fever resolution, more consistent blood and source culture acquisition, and decreased central line placement. There was no increase in related readmissions or therapeutic failures in the sustain-CCG group.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Implementation of a CCG to standardize care for musculoskeletal infections can be sustained many years after implementation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/hpeds.2020-0118","type":"journal-article","created":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T14:20:46Z","timestamp":1606832446000},"page":"1107-1113","source":"Crossref","is-referenced-by-count":13,"title":["Long-Term Impact of a Clinical Care Guideline for Pediatric Acute Musculoskeletal Infections: Are Improved Outcomes Sustainable?"],"prefix":"10.1542","volume":"10","author":[{"given":"Mackenzie N.","family":"DeVine","sequence":"first","affiliation":[{"name":"Departments of Pharmacy,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine E.","family":"MacBrayne","sequence":"additional","affiliation":[{"name":"Departments of Pharmacy,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manon C.","family":"Williams","sequence":"additional","affiliation":[{"name":"Sections of Pediatric Infectious Disease and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Pearce","sequence":"additional","affiliation":[{"name":"Infection Prevention and Control,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaylee","family":"Wickstrom","sequence":"additional","affiliation":[{"name":"Quality and Patient Safety, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Donaldson","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah K.","family":"Parker","sequence":"additional","affiliation":[{"name":"Sections of Pediatric Infectious Disease and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin B.","family":"Searns","sequence":"additional","affiliation":[{"name":"Hospital Medicine and Infectious Diseases, Department of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2020,12,1]]},"reference":[{"issue":"2","key":"2021120817570717600_B1","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.ocl.2016.12.007","article-title":"Acute hematogenous osteomyelitis in children: pathogenesis, diagnosis, and treatment","volume":"48","author":"Funk","year":"2017","journal-title":"Orthop Clin North Am"},{"issue":"10","key":"2021120817570717600_B2","doi-asserted-by":"crossref","first-page":"618","DOI":"10.5435\/00124635-200910000-00004","article-title":"Pediatric musculoskeletal infection: trends and antibiotic recommendations","volume":"17","author":"Copley","year":"2009","journal-title":"J Am Acad Orthop Surg"},{"issue":"3","key":"2021120817570717600_B3","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1093\/jpids\/pix014","article-title":"Clinical care guideline for improving pediatric acute musculoskeletal infection outcomes","volume":"6","author":"Spruiell","year":"2017","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2021120817570717600_B4","unstructured":"Parker\u2008SK, Stewart\u2008J, Heare\u2008T, et al. Musculoskeletal (MSK) infection: clinical pathway. 2012. Available at: https:\/\/www.childrenscolorado.org\/globalassets\/healthcare-professionals\/clinical-pathways\/musculoskeletal-infection.pdf. Accessed May 19, 2020"},{"issue":"1","key":"2021120817570717600_B5","doi-asserted-by":"crossref","first-page":"e20180387","DOI":"10.1542\/peds.2018-0387","article-title":"Use of a clinical care algorithm to improve care for children with hematogenous osteomyelitis","volume":"143","author":"Robinette","year":"2019","journal-title":"Pediatrics"},{"issue":"2","key":"2021120817570717600_B6","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research Electronic Data Capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"issue":"2","key":"2021120817570717600_B7","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1001\/jamapediatrics.2014.2822","article-title":"Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children","volume":"169","author":"Keren","year":"2015","journal-title":"JAMA Pediatr"},{"issue":"10","key":"2021120817570717600_B8","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1097\/INF.0000000000001245","article-title":"Handshake stewardship: a highly effective rounding-based antimicrobial optimization service","volume":"35","author":"Hurst","year":"2016","journal-title":"Pediatr Infect Dis J"},{"issue":"11","key":"2021120817570717600_B9","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1093\/cid\/ciz650","article-title":"Sustainability of handshake stewardship: extending a hand is effective years later","volume":"70","author":"MacBrayne","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"7","key":"2021120817570717600_B10","first-page":"517","article-title":"Leading practices in antimicrobial stewardship: conference summary","volume":"45","author":"Baker","year":"2019","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"2021120817570717600_B11","unstructured":"Centers for Disease Control and Prevention. The core elements of hospital antibiotic stewardship programs: 2019. Available at: https:\/\/www.cdc.gov\/antibiotic-use\/healthcare\/pdfs\/hospital-core-elements-H.pdf. Accessed August 24, 2020"},{"issue":"8","key":"2021120817570717600_B12","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1097\/01.inf.0000078901.26909.cf","article-title":"Culture-negative osteomyelitis","volume":"22","author":"Floyed","year":"2003","journal-title":"Pediatr Infect Dis J"},{"issue":"2","key":"2021120817570717600_B13","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/jpids\/pis108","article-title":"Significance of negative cultures in the treatment of acute hematogenous bone and joint infections in children","volume":"2","author":"P\u00e4\u00e4kk\u00f6nen","year":"2013","journal-title":"J Pediatric Infect Dis Soc"}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/10\/12\/1107\/813151\/hpeds_2020-0118.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/10\/12\/1107\/813151\/hpeds_2020-0118.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T19:26:29Z","timestamp":1638991589000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/10\/12\/1107\/25950\/Long-Term-Impact-of-a-Clinical-Care-Guideline-for"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,1]]},"references-count":13,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,1]]},"published-print":{"date-parts":[[2020,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2020-0118","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"value":"2154-1663","type":"print"},{"value":"2154-1671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,1]]}}}