Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Osteomyelitis

  • Initial labs and imaging
    • CBC with Diff, CRP, Blood Culture
    • Consider CK if myositis possible
    • Plain X-ray of affected area
Osteomyelitis Less Likely
Osteomyelitis Suspected
MRI not consistent
with osteomyelitis
MRI consistent
with osteomyelitis
Alternative Diagnosis
  • Treat, admit as clinically appropriate
  • Primary medical doctor follow up if symptoms do not improve
Good Treatment Response
Inadequate Treatment Response after 48-72 hours of antibiotics
  • Continued fever, pain
  • No improvement in CRP
  • Repeatedly positive blood cultures
  • Discuss changing empiric antibiotics with infectious diseases
  • Orthopedic Consultation
Inadequate Treatment Response

Discuss utility of repeat imaging and biopsy/surgical intervention with infectious diseases and orthopedics