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Acute non-traumatic hip pathology in children: incidence and presentation in family practice
Marjolein Krul1, Johannes C van der Wouden, François G Schellevis
1Department of General Practice, Erasmus MC-University Medical Center Rotterdam, Room Ff304, PO Box 2040, 3000 CA Rotterdam, The Netherlands. m.krul@erasmusmc.nl
Insights
In children with acute non-traumatic hip pathology, pain is the most common symptom. Family practitioners should monitor for fever, a key indicator differentiating benign conditions from serious ones.
Area of Science:
- Pediatric Orthopedics
- Family Medicine
- Epidemiology
Background:
- Acute non-traumatic hip pathology in children encompasses a spectrum of conditions, from transient synovitis to severe issues like septic arthritis.
- Accurate diagnosis is crucial for appropriate management and to rule out life-threatening causes.
Purpose of the Study:
- To determine population-based data on symptom presentation and incidence rates of acute non-traumatic hip pathology in children within family practice settings.
- To enhance understanding of how these hip conditions manifest in primary care.
Main Methods:
- Analysis of data from a large national survey of family practice in the Netherlands (2001).
- Inclusion of all children aged 0-14 years presenting with acute non-traumatic hip pathology.
- Calculation of incidence rates based on the number of cases and the study population at risk.
Main Results:
- The study included 73,954 children, with 101 episodes of acute non-traumatic hip pathology recorded.
- Pain was the primary presenting symptom in 81.5% of cases, followed by limping (8.6%).
- The overall incidence rate was 148.1 per 100,000 person-years, with transient synovitis at 76.2 per 100,000 person-years.
Conclusions:
- Pain is the predominant initial symptom for acute non-traumatic hip pathology in children presenting to family practice.
- Fever is a critical distinguishing factor for identifying serious hip conditions versus benign ones.
- Transient synovitis demonstrates the highest incidence rate among acute non-traumatic hip pathologies in this population.
Background:
The differential diagnosis of children with acute non-traumatic hip pathology varies from quite harmless conditions such as transient synovitis of the hip to more severe problems like Perthes' disease, slipped capital femoral epiphysis (SCFE) and life-threatening conditions such as septic arthritis of the hip.
Objective:
To provide population-based data on symptom presentation and incidence rates of non-traumatic acute hip pathology in family practice.
Methods:
We analysed data from a large national survey of family practice (104 practices), which was carried out by the Netherlands Institute for Health Services Research (NIVEL) in 2001. We included all children aged 0-14 years. Incidence rates were calculated by dividing the total number of cases (numerator) by the average study population at risk (denominator).
Results:
Our study population consisted of 73 954 children aged 0-14 years, yielding 68 202 person-years. These children presented with 101 episodes of acute non-traumatic hip pathology. The presenting feature in 81.5% of the children was pain, in 8.6% limping and 9.9% presented with both symptoms. Only 27% of the participating family practitioners (FPs) reported whether the child had a fever. The incidence rate for all acute non-traumatic hip pathology was 148.1 per 100 000 person-years, and for transient synovitis, this was 76.2 per 100 000 person-years.
Conclusion:
In family practice, most children with acute non-traumatic hip pathology present with pain as the initial symptom. FPs need to be more aware that fever is the main distinguishing factor between a harmless condition and a life-threatening condition. Transient synovitis is the diagnosis with the highest incidence rate.
