Pediatric Rheumatology Online Journal → August 2003 → Miscellaneous Clinical Studies and Case Reports → Abstract #194

MULTICENTRE AUDIT OF MUSCULOSKELETAL EXAMINATION IN GENERAL PAEDIATRICS

A. Myers,¹ J. E. McDonagh,³ K. Gupta,³ R. Hull,⁴ D. Barker,⁴ L. J. Kay,⁵ H. E. Foster.^1,2

¹Rheumatology Department, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom; ²Child Health, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom; ³Institute of Child Health, Birmingham Children's Hospital, Birmingham, United Kingdom; ⁴Rheumatology & Paediatric Departments, Queen Alexandra Hospital, Portsmouth, United Kingdom; ⁵Rheumatology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom

Objective.To describe case-note documentation of musculoskeletal examination in routine paediatric medical clerking.
Methods Case-notes of consecutive paediatric medical patients admitted to 3 hospitals over a 4 week period were audited. To be included all patients had to be reviewed by a Consultant. A proforma was used to include presenting complaint, in particular musculoskeletal symptoms, a record of systems examined and the findings.
Results 257 case notes were included (Newcastle n=105, Birmingham n=100, Portsmouth n=52). Analysed together the median age was 3 years (range 0-18), with 117 females.The systems examined were respiratory (RS, 97% of patients), cardiovascular (CVS, 95%), abdominal (GI, 95%), central nervous system (CNS, 38%), skin (32%), eyes (10%), musculoskeletal (MSK, 4%). 11 patients had a MSK examination, and the recorded diagnoses were [ldquo>limp[rdquo>, reactive arthritis, back pain, impetigo, diarrhoea, asthma: in all 11 cases the examination was limited (eg. hips only examined or range of movement only). 7 patients were documented to have been asked about MSK complaints, yet only 4 had documented joint examination performed; this was a limited examination in all cases and none had gait examined. Similar trends were noted in all 3 hospitals.
Conclusions MSK examination was rarely recorded which contrasts markedly with other systems which were examined in most children irrespective of presenting complaint. Even in those children presenting with MSK complaints, a record of MSK examination was sometimes not recorded in the notes and in most cases any attempt at MSK examination was limited. MSK problems in children are common and can be the presentation of severe, life threatening disease. This audit shows that MSK examination is not part of the routine medical examination in children and this needs to be addressed in undergraduate and postgraduate training.