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INTRODUCTION: Management of atraumatic extremity pain in a pediatric patient often poses a dilemma to the treating orthopedic surgeon. The benefits of timely intervention must often be weighed against the utility of preoperative MRI to better characterize the responsible infection or other pathology. To determine if outcomes were superior for patients who underwent preoperative vs. postoperative MRI, this multicenter study reviewed the hospital courses of pediatric patients who presented with atraumatic extremity pain, underwent irrigation and debridement, and received at least one preoperative or postoperative MRI during their admission. METHODS: This study is a multi-institution retrospective review from four pediatric tertiary referral centers of patients 0-16 years who presented with atraumatic pain of an extremity, underwent irrigation and debridement, and received at least one preoperative or postoperative MRI from 2010 through 2019. Primary outcomes were time to OR, length of stay (LOS), number of MRIs, and number of I&Ds. Secondary outcomes included accompanying aspirations, number of hospitalizations, acuity of symptoms, and laboratory test results. RESULTS: 158 patients were identified, of which 77.2% had at least one preoperative MRI while 22.8% only had postoperative MRI. Members of the postoperative MRI cohort were more likely to undergo aspiration during admission (p<0.0001). Patients that received preoperative MRI had significantly greater time to OR (mean difference 1.07 days, p=0.0003). There were no significant differences in the average LOS (p=0.4029), total number of surgeries (p=0.2314), total number of MRIs (p=0.5015), and total hospitalizations (p=0.2158). When limiting the analysis to the 63 patients who were diagnosed with a septic joint, time to OR remained the only significant difference in outcome (p=0.0003). DISCUSSION: Pediatric patients that received preoperative MRIs had longer time to OR and greater overall numbers of MRIs without any reductions in LOS, additional surgeries, or total number of hospitalizations. In patients with clinical and laboratory findings concerning for infection with radiographs and/or aspiration supporting a diagnosis of osteomyelitis, abscess, or septic joint, preoperative MRI may not be necessary


Mid-America Orthopaedic Association 40th Annual Meeting, April 19 – 23, 2023, Miramar Beach, Florida

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