A clinical practice guideline for treatment of septic arthritis in children: efficacy in improving process of care and effect on outcome of septic arthritis of the hip.
BACKGROUND
The development of clinical practice guidelines is a central precept of the evidence-based-medicine movement. The purposes of this study were to develop a guideline for the treatment of septic arthritis in children and to evaluate its efficacy with regard to improving the process of care and its effect on the outcome of septic arthritis of the hip in children.


METHODS
A clinical practice guideline was developed by an interdisciplinary expert committee using evidence-based techniques. Efficacy was evaluated by comparing a historical control group of thirty consecutive children with septic arthritis of the hip managed before the utilization of the guideline with a prospective cohort group of thirty consecutive children treated with use of the guideline. Benchmark parameters of process and outcome were compared between groups.


RESULTS
The patients treated with use of the guideline, compared with those treated without use of the guideline, had a significantly higher rate of performance of initial and follow-up C-reactive protein tests (93% compared with 13% and 70% compared with 7%), lower rate of initial bone-scanning (13% compared with 40%), lower rate of presumptive drainage (13% compared with 47%), greater compliance with recommended antibiotic therapy (93% compared with 7%), faster change to oral antibiotics (3.9 compared with 6.9 days), and shorter hospital stay (4.8 compared with 8.3 days). There were no significant differences between the groups with regard to other process variables, and there were no significant differences with regard to outcome variables, including readmission to the hospital, recurrent infection, recurrent drainage, development of osteomyelitis, septic osteonecrosis, or limitation of motion.


CONCLUSIONS
Patients treated according to the septic arthritis clinical practice guideline had less variation in the process of care and improved efficiency of care without a significant difference in outcome.
Kocher
Mininder S
MS
Department of Orthopaedic Surgery, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. mininder.kocher@tch.harvard.edu
Mandiga
Rahul
R
Murphy
Jane M
JM
Goldmann
Donald
D
Harper
Marvin
M
Sundel
Robert
R
Ecklund
Kirsten
K
Kasser
James R
JR
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000628:therapy*; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D005260:Female; D006621:Hip Joint; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents