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Osteomyelitis Clinical Pathway – Emergency Department and Inpatient

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

Exclusion Criteria

 
 

Triage

Analgesia as indicated
 
 

Team Assessment

 
 
Sepsis Pathway, as indicated
 
 
 
 
Osteomyelitis Less Likely
Osteomyelitis Suspected
  • Start empiric antibiotics
  • Order MRI with contrast
    • Order while in ED
    • Admission should not be delayed for MRI
    • Consult sedation/anesthesia as appropriate
  • Admit to general pediatrics
 
 
 
 
 
 
MRI not consistent with osteomyelitis
MRI consistent with osteomyelitis
Consider discontinuing empiric antibiotics
 
 
  • Treat, admit as clinically appropriate
  • Primary care follow-up if symptoms do not improve
 
 
 
 
Adequate treatment response
Inadequate treatment response after 48–72 hrs of antibiotics
  • Continued fever, pain
  • No improvement in CRP
  • Repeatedly positive blood cultures
  • Consult ID and Orthopedics if not already done
  • Consider changing empiric antibiotics
  • Consider repeat imaging and biopsy/surgical intervention
 
 
Follow-up with ID for repeat labs and antibiotic duration
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