{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:39:35Z","timestamp":1787755175854,"version":"build-2784847793"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n \n \n \u00bb A team approach is optimal in the evaluation and treatment of musculoskeletal infection in pediatric patients given the complexity and uncertainty with which such infections manifest and progress, particularly among severely ill children.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb The team approach includes emergency medicine, pediatric intensive care, pediatric hospitalist medicine, infectious disease service, orthopaedic surgery, radiology, anesthesiology, pharmacology, and hematology.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb These services follow evidence-based clinical practice guidelines with integrated processes of care so that children and their families may benefit from data-driven continuous process improvement.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb Important principles based on our experience in the successful treatment of pediatric musculoskeletal infection include relevant information gathering, pattern recognition, determination of the severity of illness, institutional workflow management, closed-loop communication, patient and family-centered care, ongoing dialogue among key stakeholders within and outside the context of direct patient care, and periodic data review for programmatic improvement over time.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb Such principles may be useful in almost any setting, including rural communities and developing countries, with the understanding that the team composition, institutional capabilities or limitations, and specific approaches to treatment may differ substantially from one setting or team to another.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>","DOI":"10.2106\/jbjs.rvw.19.00121","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T00:27:33Z","timestamp":1585009653000},"page":"e0121-e0121","source":"Crossref","is-referenced-by-count":8,"title":["Team Approach: Pediatric Musculoskeletal Infection"],"prefix":"10.2106","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0935-1555","authenticated-orcid":false,"given":"Archana V.","family":"Dhar","sequence":"first","affiliation":[{"name":"University of Texas Southwestern, Dallas, Texas"},{"name":"Children\u2019s Health System of Texas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1353-8267","authenticated-orcid":false,"given":"Craig J.","family":"Huang","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern, Dallas, Texas"},{"name":"Children\u2019s Health System of Texas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9750-9107","authenticated-orcid":false,"given":"Paul K.","family":"Sue","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern, Dallas, Texas"},{"name":"Children\u2019s Health System of Texas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6127-9760","authenticated-orcid":false,"given":"Karisma","family":"Patel","sequence":"additional","affiliation":[{"name":"Children\u2019s Health System of Texas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0586-3270","authenticated-orcid":false,"given":"Alan C.","family":"Farrow-Gillespie","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern, Dallas, Texas"},{"name":"Children\u2019s Health System of Texas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2693-9465","authenticated-orcid":false,"given":"Matthew R.","family":"Hammer","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern, Dallas, Texas"},{"name":"Children\u2019s Health System of Texas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3283-0415","authenticated-orcid":false,"given":"Ayesha N.","family":"Zia","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern, Dallas, Texas"},{"name":"Children\u2019s Health System of Texas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4489-8356","authenticated-orcid":false,"given":"Vineeta S.","family":"Mittal","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern, Dallas, Texas"},{"name":"Children\u2019s Health System of Texas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4325-2414","authenticated-orcid":false,"given":"Lawson A.","family":"Copley","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern, Dallas, Texas"},{"name":"Children\u2019s Health System of Texas, Dallas, Texas"},{"name":"Texas Scottish Rite Hospital for Children, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,3]]},"reference":[{"issue":"8","key":"r1-20230807","doi-asserted-by":"crossref","first-page":"686","DOI":"10.2106\/JBJS.L.00037","article-title":"The impact of evidence-based clinical practice guidelines applied by a multidisciplinary team for the care of children with osteomyelitis","volume":"95","author":"Copley","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"22","key":"r2-20230807","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.2106\/JBJS.O.00403","article-title":"Improved magnetic resonance imaging utilization for children with musculoskeletal infection","volume":"97","author":"Mueller","year":"2015","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"r3-20230807","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/INF.0000000000002044","article-title":"Severity adjusted risk of long-term adverse sequelae among children with osteomyelitis","volume":"38","author":"Vorhies","year":"2019","journal-title":"Pediatr Infect Dis J"},{"issue":"2","key":"r4-20230807","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1097\/CCM.0b013e31827e83af","article-title":"Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012","volume":"41","author":"Dellinger","year":"2013","journal-title":"Crit Care Med"},{"issue":"8","key":"r5-20230807","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1097\/CCM.0000000000000330","article-title":"Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program","volume":"42","author":"Ferrer","year":"2014","journal-title":"Crit Care Med"},{"issue":"11","key":"r6-20230807","doi-asserted-by":"crossref","first-page":"S513","DOI":"10.1097\/01.CCM.0000143119.41916.5D","article-title":"Source control in the management of severe sepsis and septic shock: an evidence-based review","volume":"32","author":"Marshall","year":"2004","journal-title":"Crit Care Med"},{"issue":"5","key":"r7-20230807","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1097\/BPO.0000000000000136","article-title":"Clinical and laboratory parameters associated with multiple surgeries in children with acute hematogenous osteomyelitis","volume":"34","author":"Tuason","year":"2014","journal-title":"J Pediatr Orthop"},{"issue":"10","key":"r8-20230807","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1097\/INF.0000000000001272","article-title":"Sequential parenteral to oral clindamycin dosing in pediatric musculoskeletal infection: a retrospective review of 30mg\/kg\/d vs 40mg\/kg\/d","volume":"35","author":"Erickson","year":"2016","journal-title":"Pediatr Infect Dis J"},{"issue":"4","key":"r9-20230807","doi-asserted-by":"crossref","first-page":"e155","DOI":"10.1097\/INF.0b013e318286378e","article-title":"Improved vancomycin dosing in children using area under the curve exposure","volume":"32","author":"Le","year":"2013","journal-title":"Pediatr Infect Dis J"},{"issue":"4","key":"r10-20230807","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1373\/jalm.2018.027391","article-title":"AUC-based monitoring of vancomycin: closing the therapeutic window","volume":"3","author":"Biagi","year":"2019","journal-title":"J Appl Lab Med"},{"issue":"4","key":"r11-20230807","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1055\/s-0037-1613054","article-title":"Comparison of venography and ultrasound for the diagnosis of asymptomatic deep vein thrombosis in the upper body in children: results of the PARKAA study. Prophylactic Antithrombin Replacement in Kids with ALL treated with Asparaginase","volume":"87","author":"Male","year":"2002","journal-title":"Thromb Haemost"},{"issue":"1","key":"r12-20230807","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/INF.0000000000000002","article-title":"A proposed scoring system for assessment of severity of illness in pediatric acute hematogenous osteomyelitis using objective clinical and laboratory findings","volume":"33","author":"Copley","year":"2014","journal-title":"Pediatr Infect Dis J"},{"issue":"2","key":"r13-20230807","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/BPO.0000000000000879","article-title":"Validation and modification of a severity of illness score for children with acute hematogenous osteomyelitis","volume":"39","author":"Athey","year":"2019","journal-title":"J Pediatr Orthop"},{"issue":"10","key":"r14-20230807","doi-asserted-by":"crossref","first-page":"e597","DOI":"10.1097\/BPO.0000000000001240","article-title":"Differentiation of deep venous thrombosis among children with or without osteomyelitis","volume":"38","author":"Ligon","year":"2018","journal-title":"J Pediatr Orthop"},{"issue":"6","key":"r15-20230807","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1097\/01.CCM.0000217961.75225.E9","article-title":"Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock","volume":"34","author":"Kumar","year":"2006","journal-title":"Crit Care Med"},{"issue":"4","key":"r16-20230807","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/CCM.0000000000002262","article-title":"Increased time to initial antimicrobial administration is associated with progression to septic shock in severe sepsis patients","volume":"45","author":"Whiles","year":"2017","journal-title":"Crit Care Med"},{"issue":"7","key":"r17-20230807","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.2106\/00004623-200707000-00016","article-title":"Deep venous thrombosis associated with osteomyelitis in children","volume":"89","author":"Hollmig","year":"2007","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"r18-20230807","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1182\/blood.V83.5.1251.1251","article-title":"Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE","volume":"83","author":"Andrew","year":"1994","journal-title":"Blood"},{"issue":"4","key":"r19-20230807","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1542\/peds.2009-0768","article-title":"Dramatic increase in venous thromboembolism in children\u2019s hospitals in the United States from 2001 to 2007","volume":"124","author":"Raffini","year":"2009","journal-title":"Pediatrics"},{"issue":"2","key":"r20-20230807","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.1097\/MPH.0000000000001040","article-title":"Pediatric deep venous thrombosis associated with staphylococcal infections: single institutional experience","volume":"40","author":"Citla Sridhar","year":"2018","journal-title":"J Pediatr Hematol Oncol"},{"issue":"4","key":"r21-20230807","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jpeds.2006.06.067","article-title":"Venous thrombosis and thromboembolism in children with osteomyelitis","volume":"149","author":"Crary","year":"2006","journal-title":"J Pediatr"},{"issue":"3","key":"r22-20230807","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1542\/hpeds.2012-0011","article-title":"When should DVT be suspected in children with osteomyelitis?","volume":"2","author":"Altobelli","year":"2012","journal-title":"Hosp Pediatr"},{"issue":"6","key":"r23-20230807","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1097\/CCM.0000000000002425","article-title":"American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock","volume":"45","author":"Davis","year":"2017","journal-title":"Crit Care Med"},{"key":"r24-20230807","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1186\/s13054-015-1105-4","article-title":"Extracorporeal therapies in pediatric severe sepsis: findings from the pediatric health-care information system","volume":"19","author":"Ruth","year":"2015","journal-title":"Crit Care"},{"issue":"2","key":"r25-20230807","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/PCC.0b013e3181e2a4a1","article-title":"Central extracorporeal membrane oxygenation for refractory pediatric septic shock","volume":"12","author":"MacLaren","year":"2011","journal-title":"Pediatr Crit Care Med"},{"issue":"7","key":"r26-20230807","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.1097\/CCM.0b013e31828a2370","article-title":"Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock","volume":"41","author":"Br\u00e9chot","year":"2013","journal-title":"Crit Care Med"},{"issue":"7","key":"r27-20230807","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1097\/BPO.0b013e318186eb4b","article-title":"The impact of the current epidemiology of pediatric musculoskeletal infection on evaluation and treatment guidelines","volume":"28","author":"Gafur","year":"2008","journal-title":"J Pediatr Orthop"},{"issue":"6","key":"r28-20230807","doi-asserted-by":"crossref","first-page":"441","DOI":"10.2106\/JBJS.N.00477","article-title":"Microbiological culture methods for pediatric musculoskeletal infection: a guideline for optimal use","volume":"97","author":"Section","year":"2015","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"r29-20230807","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1093\/cid\/cir034","article-title":"Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary","volume":"52","author":"Liu","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"2","key":"r30-20230807","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1128\/mBio.00186-18","article-title":"Rapid growth of uropathogenic Escherichia coli during human urinary tract infection","volume":"9","author":"Forsyth","year":"2018","journal-title":"MBio"},{"issue":"1","key":"r31-20230807","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1186\/s13054-018-2147-1","article-title":"The path to great pediatric septic shock outcomes","volume":"22","author":"Ames","year":"2018","journal-title":"Crit Care"},{"issue":"1880","key":"r32-20230807","first-page":"1","article-title":"The distribution of bacterial doubling times in the wild","volume":"285","author":"Gibson","year":"2018","journal-title":"Proc Biol Sci"},{"issue":"1","key":"r34-20230807","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jcrc.2013.09.008","article-title":"Indications and outcomes in children receiving renal replacement therapy in pediatric intensive care","volume":"29","author":"Boschee","year":"2014","journal-title":"J Crit Care"},{"issue":"2","key":"r35-20230807","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1053\/j.ajkd.2009.10.048","article-title":"Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry","volume":"55","author":"Sutherland","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"r36-20230807","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.thromres.2015.11.029","article-title":"Clinical variables and Staphylococcus aureus virulence factors associated with venous thromboembolism in children","volume":"138","author":"Carpenter","year":"2016","journal-title":"Thromb Res"},{"issue":"1","key":"r37-20230807","doi-asserted-by":"crossref","first-page":"82","DOI":"10.2146\/ajhp080434","article-title":"Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists","volume":"66","author":"Rybak","year":"2009","journal-title":"Am J Health Syst Pharm"},{"issue":"6","key":"r38-20230807","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/pan.13390","article-title":"The impact of general anesthesia on child development and school performance: a population-based study","volume":"28","author":"Schneuer","year":"2018","journal-title":"Paediatr Anaesth"},{"issue":"6","key":"r39-20230807","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.2214\/AJR.14.13869","article-title":"Pulmonary embolism in children","volume":"204","author":"Thacker","year":"2015","journal-title":"AJR Am J Roentgenol"},{"issue":"4","key":"r40-20230807","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.mric.2017.06.007","article-title":"Gadolinium deposition and chronic toxicity","volume":"25","author":"Ramalho","year":"2017","journal-title":"Magn Reson Imaging Clin N Am"},{"issue":"5","key":"r41-20230807","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s00234-016-1658-1","article-title":"Gadolinium deposition within the dentate nucleus and globus pallidus after repeated administrations of gadolinium-based contrast agents-current status","volume":"58","author":"Stojanov","year":"2016","journal-title":"Neuroradiology"},{"key":"r42-20230807","doi-asserted-by":"crossref","first-page":"3918292","DOI":"10.1155\/2016\/3918292","article-title":"Immediate adverse reactions to gadolinium-based MR contrast media: a retrospective analysis on 10,608 examinations","volume":"2016","author":"Granata","year":"2016","journal-title":"BioMed Res Int"},{"issue":"4","key":"r43-20230807","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1160\/TH12-08-0543","article-title":"Methicillin-resistant Staphylococcus aureus-induced thrombo-inflammatory response is reduced with timely antibiotic administration","volume":"109","author":"Franks","year":"2013","journal-title":"Thromb Haemost"},{"issue":"7","key":"r44-20230807","doi-asserted-by":"crossref","first-page":"e103523","DOI":"10.1371\/journal.pone.0103523","article-title":"Gene expression analysis of children with acute hematogenous osteomyelitis caused by methicillin-resistant Staphylococcus aureus: correlation with clinical severity of illness","volume":"9","author":"Gaviria-Agudelo","year":"2014","journal-title":"PLoS One"},{"issue":"1","key":"r45-20230807","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1055\/s-2001-14540","article-title":"Clinical and laboratory diagnosis of deep vein thrombosis: new cost-effective strategies","volume":"1","author":"Bounameaux","year":"2001","journal-title":"Semin Vasc Med"},{"issue":"25","key":"r46-20230807","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.1182\/bloodadvances.2017009514","article-title":"A clinical audit of thrombophilia testing in pediatric patients with acute thromboembolic events: impact on management","volume":"1","author":"Gavva","year":"2017","journal-title":"Blood Adv"},{"issue":"22","key":"r47-20230807","doi-asserted-by":"crossref","first-page":"3292","DOI":"10.1182\/bloodadvances.2018024786","article-title":"American Society of Hematology 2018 guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism","volume":"2","author":"Monagle","year":"2018","journal-title":"Blood Adv"},{"key":"r48-20230807","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1182\/asheducation.V2015.1.111.3917444","article-title":"Anticoagulants in children and adolescents","volume":"2015","author":"Young","year":"2015","journal-title":"Hematology (Am Soc Hematol Educ Program)"},{"key":"r49-20230807","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.thromres.2017.10.003","article-title":"Markers of coagulation activation, inflammation and fibrinolysis as predictors of poor outcomes after pediatric venous thromboembolism: a systematic review and meta-analysis","volume":"160","author":"Zia","year":"2017","journal-title":"Thromb Res"}],"container-title":["JBJS Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.RVW.19.00121","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:38:42Z","timestamp":1787751522000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.RVW.19.00121"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":48,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.rvw.19.00121","relation":{},"ISSN":["2329-9185"],"issn-type":[{"value":"2329-9185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}