In paediatric patients with suspected osteomyelitis, magnetic resonance imaging (MRI) remains an essential diagnostic tool. Timely access to an MRI scanner remains a challenge in the Canadian system. For some paediatric patients, the need for sedation can introduce considerable time delays, particularly for those admitted to services who may rely heavily on radiology image interpretation. This study aimed to assess the current delivery of care for osteomyelitis by analyzing MRI wait times, the use of contrast and sedation, and associated patient outcomes. A single-centre retrospective cohort study from a level one paediatric children's hospital was performed. Data were collected from electronic medical records of paediatric patients with a diagnosis of osteomyelitis from December 1, 2018 to December 31, 2023. Records were reviewed to collect patient factors (e. g. , age, sex, comorbidities), relevant MRI parameters (e. g. , time of order, time of image acquisition, contrast, sedation), non-surgical and surgical management, involvement of infectious diseases, length of stay in the hospital, follow-up complications, and follow-up MRI. Patient data were compared based on time from the MRI order to image acquisition and interpretation. Continuous variables were assessed for normality using a Shapiro-Wilks test to determine the use of parametric or non-parametric tests. Regression analyses were performed to identify predictive indicators of delays in MRI image acquisition and treatment for osteomyelitis. A total of 60 pediatric patients with a definitive diagnosis of osteomyelitis had undergone an MRI at our center. The cohort consisted of 33 (55%) males with a mean age of 8. 5 (+/- 4. 5) years old. The average length of hospital stay for these patients was 9. 4 (+/- 10. 1) days. Patients with both osteomyelitis and a soft tissue abscess were more often admitted and underwent surgery more frequently, although these differences did not reach statistical significance. Contrast was indicated and administered in 95% of all MRI scans, with 19 (32%) of total scans performed with sedation. There were no differences in MRI acquisition time before, during, nor after the COVID-19 pandemic for these patients. The average time from MRI order to scan acquisition was 48. 2 (+/- 41. 8) hours for sedated patients, compared to 40. 4 (+/- 30. 6) hours for those not sedated, with no statistically significant difference between groups. The time from MRI order to interpretation followed similarly in the sedated scans, 53. 3 (+/- 43. 4) hours, and unsedated scans, 51. 7 (+/−46. 9) hours, with differences not found to be statistically significant. Based on our hospital's average hourly cost of pediatric inpatient care, the time from image request to formalized interpretation reached 3, 405. 87 for sedated scans and 3, 303. 63 for unsedated scans. Overall, the findings indicate delays in obtaining MRI scans, irrespective of need for sedation, which can contribute to prolonged hospital stays, increased costs and potentially delay in care. The substantial wait times for diagnostic MRIs highlight a critical area for quality improvement initiatives, suggesting that enhanced prioritization or further resource allocation for paediatric patients must be considered. Further, emphasis on incorporating rapid whole-body MRI scout protocols could significantly enhance patient care, image acquisition time and efficiency.
Hoveyda et al. (Wed,) studied this question.