A disjointed effort: paediatric musculoskeletal examination

Area of Science:

• Pediatric Emergency Medicine
• Orthopedic Pediatrics
• Clinical Quality Improvement

Background:

• Musculoskeletal (MSK) symptoms are common in pediatric emergency department visits.
• While often benign, MSK symptoms can indicate serious conditions like leukemia or juvenile idiopathic arthritis.
• MSK examination is frequently omitted from routine pediatric assessments.

Purpose of the Study:

• To evaluate the frequency and thoroughness of MSK examinations in pediatric admissions.
• To compare MSK examination practices with those of other symptom evaluations.
• To assess the impact of an awareness campaign on MSK examination rates.

Main Methods:

• Retrospective review of 100 consecutive pediatric patient records.
• Implementation of an awareness campaign (posters, presentations) on MSK examination.
• Second retrospective review of 100 consecutive pediatric patient records post-campaign.

Main Results:

• Routine MSK examination increased from 9% to 32% after the awareness campaign.
• Examinations, when performed, were often incomplete, focusing only on the affected site or single joint.
• Non-limb joints were rarely examined, even when joint stiffness was a presenting complaint.

Conclusions:

• MSK examination is not routinely performed during pediatric admissions, unlike other symptom evaluations.
• Incomplete examinations are common, potentially missing crucial diagnostic information.
• Local audits and enhanced undergraduate teaching are recommended to improve MSK examination practices.