Poor Sensitivity of Musculoskeletal History in Children
Poor Sensitivity of Musculoskeletal History in Children
A retrospective case-note review compared the symptomatic joints identified on history taking versus abnormal joints subsequently found on examination. Case notes for all new patient referrals to a paediatric rheumatologist (HF) over a 12-month period were obtained. The number, distribution and nature of abnormal joints elicited in the history were recorded on a prepiloted anonymised pro forma including a schematic diagram of joints (homunculus). Abnormal joints identified on clinical examination were recorded on a further paired homunculus. These data informed the power calculation (80% power, p=0.05) for the prospective study of (1) consecutive paediatric rheumatology clinic attendees (new/review) and (2) consecutive new patients in an acute children's assessment unit (CAU). The same pro forma was used throughout, completed by consultant/final year trainee in rheumatology clinics and by a primary care teaching fellow (IG) in the CAU. Joint involvement elicited from the history was documented before the examination, with abnormalities recorded in free text (eg, swelling, restricted movement).
Ethical approval was obtained for the arm of the study based in CAU, while the paediatric rheumatology arm was registered as an audit of practice. Joint examination was conducted using pGALS and subsequent more detailed joint examination as appropriate in clinical practice.
Methods
A retrospective case-note review compared the symptomatic joints identified on history taking versus abnormal joints subsequently found on examination. Case notes for all new patient referrals to a paediatric rheumatologist (HF) over a 12-month period were obtained. The number, distribution and nature of abnormal joints elicited in the history were recorded on a prepiloted anonymised pro forma including a schematic diagram of joints (homunculus). Abnormal joints identified on clinical examination were recorded on a further paired homunculus. These data informed the power calculation (80% power, p=0.05) for the prospective study of (1) consecutive paediatric rheumatology clinic attendees (new/review) and (2) consecutive new patients in an acute children's assessment unit (CAU). The same pro forma was used throughout, completed by consultant/final year trainee in rheumatology clinics and by a primary care teaching fellow (IG) in the CAU. Joint involvement elicited from the history was documented before the examination, with abnormalities recorded in free text (eg, swelling, restricted movement).
Ethical approval was obtained for the arm of the study based in CAU, while the paediatric rheumatology arm was registered as an audit of practice. Joint examination was conducted using pGALS and subsequent more detailed joint examination as appropriate in clinical practice.
Source...