Pediatric Rheumatology Online Journal → August 2003 → Miscellaneous Clinical Studies and Case Reports → Abstract #195

APPLICATION OF THE ADULT GALS SCREENING EXAMINATION IN SCHOOL AGE CHILDREN

A. Myers,¹ L. J. Kay,³ M. Friswell,⁴ M. Abumin,⁴ 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; ³Rheumatology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom; ⁴Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom

Objective Assess the applicability of the adult GALS screening examination to school age children.
Methods Consecutive school age children (new/review patients) attending the Paediatric Rheumatology clinic were examined by a Yr 4 Rheumatology SpR (AM) who performed a GALS examination (without a history being taken and blinded to the diagnosis). All patients were examined, the same day by a Paediatric Rheumatologist (HF/MF). Both examinations were recorded separately using a proforma and the examiners were blinded to each others findings.
Results 33 patients (17 female, median age 10 years (range 4-16)) were recruited over a 4 week period. Diagnoses recorded included inflammatory arthritis [(JIA, n=23), SLE (n=2)>, osteogenesis imperfecta (n=1), joint hypermobility (n=5) and anterior knee pain (n=2).Examination of the hands and lumbar spine using the GALS screen identifies significant locomotor disease with specificities,sensitivities,positive predictive values and negative predictive values of 100%. Examination of neck,wrists,elbows,shoulders,hips and kness have sensitivities of 100%, specificities of greater than 80% and negative predictive values of 100%. Sensitivities and specificities for ankle,foot and TMJ disease were zero.
The GALS screen had high sensitivities/ specificities for examining most joints, but missed important abnormalities including ankle, foot and TMJ disease, leg length discrepancies, hypermobility, patella tendon insertion pain, enthesitis, trendelenberg positive hip disease, and tenosynovitis.
Conclusions The adult GALS screen is a useful screening examination tool but needs to be modified for routine use in school age children as it misses common and important features of JIA and other common rheumatic problems that present in this age group