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G102. MULTICENTRE AUDIT OF MUSCULOSKELETAL EXAMINATION IN GENERAL PAEDIATRICS
A. Myers1, J.E. McDonagh3, K. Gupta3, R. Hull4, D. Barker4, L.J. Kay5, H.E. Foster1,2.
Departments of 1 Rheumatology and 2 Child Health, University of Newcastle upon Tyne; 3 Department of Child Health, Birmingham; 4 Department of Paediatrics, Queen Alexandra Hospital Portsmouth; 5 Department of Rheumatology, Newcastle Hospitals NHS Trust
Objective: To describe case note documentation of musculoskeletal examination in routine paediatric medical clerking.
Methods: Case notes of consecutive paediatric medical patients admitted to 3 UK hospitals over a 4 week period were audited. All patients had to be reviewed by a Consultant. A standard proforma was used to include presenting complaint, in particular musculoskeletal symptoms, a record of systems examined and the findings, whether normal or abnormal.
Results: 257 case notes were included (Newcastle n=105, Birmingham n=100, Portsmouth n=52). The median age was 3 years (range 0–18), with 117 females. Diagnoses recorded (descending order) were infections, asthma, abdominal pain, headache, rash, accidental poisoning and problems relating to chronic diseases. Systems examined were respiratory (RS, 97% of patients), cardiovascular (CVS, 95%), abdominal (GI, 95%), central nervous system (CNS, 38%), skin (32%), eyes (10%), musculoskeletal (MSK, 4%). 11 patients had a MSK examination, and the recorded diagnoses were “limp”, reactive arthritis, back pain, impetigo, diarrhoea, asthma: in all 11 cases the examination was limited (eg. hips only examined). 7 patients were documented to have been asked about MSK complaints, yet only 4 had documented joint examination performed. Similar trends were noted in all 3 hospitals.
Conclusions: MSK examination was rarely recorded, which contrasts markedly with other systems which were examined in most children irrespective of the presenting complaint. Even in those children presenting with MSK complaints, a record of MSK examination was sometimes not recorded in the notes …