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Published on: November 7, 2014
Atraumatic Limping Child, a Challenge for Pediatricians: An Observational Age-Related Study in a Pediatric Emergency
Sebastian Cristaldi1, Alessandra Boni2, Valentina Ferro1
1General Pediatrics and ED 2nd Level, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Insights
Pediatric limping requires careful evaluation, especially in toddlers. Identifying red flags during clinical assessment is crucial for diagnosing severe underlying conditions in children presenting with atraumatic limping.
Area of Science:
- Pediatric Emergency Medicine
- Musculoskeletal Disorders
- Diagnostic Challenges
Background:
- Atraumatic limping is a common pediatric emergency department presentation.
- Etiologies range from benign to severe, posing diagnostic challenges for clinicians.
Purpose of the Study:
- To describe clinical features of acute limping children.
- To identify red flags indicative of severe pathologies.
Main Methods:
- Retrospective study of 485 non-traumatic limping children in a pediatric emergency department.
- Patients categorized by age: toddlers, children, and adolescents.
- Crippling conditions included oncologic, infectious, orthopedic, neurological, and non-accidental injury etiologies.
Main Results:
- 19.5% of patients exhibited red flag signs/symptoms.
- Severe conditions accounted for 6.2% of cases, with 36.7% showing red flags.
- Transient synovitis was the most frequent diagnosis; 30 patients had severe conditions, predominantly toddlers.
Conclusions:
- Toddlers and children with red flags warrant heightened suspicion for severe underlying conditions.
- Early identification of red flags aids in timely diagnosis and management of serious pediatric limping cases.
Background:
Atraumatic limping is a frequent cause of consultation in Pediatric Emergency Departments (PED) and often represents a challenge for pediatricians for its variability in etiology ranging from benign causes to potential crippling conditions. The aims of this research are to illustrate the clinical features of acute limping children (LC) and to identify the possible red flags that could help to make a diagnosis of severe pathologies.
Methods:
We carried out a retrospective study about non-traumatic limping children referred to the PED of Bambino Gesù Children's Hospital over a 2-year period. We divided the cohort into three groups based on the patient's age: toddlers, children and adolescents. We considered crippling conditions: oncologic etiologies, bone or neurological infections, epiphysiolysis, Perthes disease, Guillain Barrè syndrome and non-accidental injuries.
Results:
We analyzed 485 patients. At clinical evaluation, 19.5% of the patients presented at least one sign and/or symptom of red flags. Crippling conditions (6.2% of the total population) showed red flags in 36.7%. Transient synovitis of the hip was the most frequent diagnosis. We found crippling conditions in 30 patients, mostly represented by toddlers.
Conclusions:
Our data suggest that toddlers and patients presenting red flags should be evaluated with particular suspicion because they have an increased risk of underlying severe conditions.
