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ACR Appropriateness Criteria® limping child--ages 0 to 5 years
Sarah S Milla1, Brian D Coley, Boaz Karmazyn
1New York University Langone Medical Center, New York, NY, USA. sarah.milla@nyumc.org
Insights
Choosing the right imaging for limping children (0-5 years) relies on clinical signs like infection, pain location, and trauma history. This guide reviews common causes and appropriate imaging techniques for pediatric limping.
Area of Science:
- Pediatric Radiology
- Orthopedic Imaging
Background:
- Limping in young children (0-5 years) is a common clinical concern.
- Diagnosis requires careful consideration of clinical presentation, including signs of infection, pain localization, and trauma history.
Purpose of the Study:
- To outline appropriate imaging strategies for pediatric patients presenting with a limp.
- To review common causes of limping in children and their recommended imaging modalities.
Main Methods:
- Review of common pediatric limping diagnoses: toddler's fracture, transient synovitis, septic arthritis, Legg-Calvé-Perthes disease, and osteomyelitis.
- Discussion of recommended imaging techniques based on clinical presentation.
- Reference to the ACR Appropriateness Criteria(®) as evidence-based guidelines.
Main Results:
- Imaging selection is contingent upon specific clinical findings such as infection indicators, pain site, and trauma history.
- Guidelines provide a framework for selecting the most appropriate imaging procedures.
- Expert opinion supplements evidence where data is limited.
Conclusions:
- Tailored imaging based on clinical assessment is crucial for diagnosing the cause of limping in young children.
- The ACR Appropriateness Criteria(®) offer valuable guidance for pediatric limping evaluation.
- A systematic approach ensures optimal diagnostic yield and appropriate patient care.
Abstract:
The appropriate imaging for pediatric patients (ages 0-5 years) being evaluated for limping depends on the clinical presentation, specifically, the presence of signs of infection, any localization of pain, and history of or suspected trauma. Common diagnoses causing limping in children are briefly reviewed, and recommended imaging techniques are discussed, including toddler's fracture, transient synovitis, septic arthritis, Legg-Calvé-Perthes disease, and osteomyelitis. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
