Aims To assess if the musculoskeletal (MSK) examination was being performed, in eight paediatric centres across Yorkshire, when the clinical situation would suggest it was warranted, using the pGALS examination tool 1
Methods 397 case notes were randomly collected and reviewed retrospectively for patients who had presented to hospital between August-November 2012. Each centre assessed approximately 50 sets of patient’s notes
The admission notes were reviewed to find out whether a MSK examination had been documented by the doctors on the initial assessment and then the first and second reviews, if there were triggers or red flags for the examination.¹
Evidence of documentation of the systemic clinical examinations performed and pertinent clinical variables, including times of admission and the grade of the doctors reviewing patients, were noted.
The information was collected on excel spreadsheets at source hospitals and collated by the audit team to investigate the trends across Yorkshire.
Results 35% of the 397 admissions had a trigger for a MSK examination.
26% of the 397 admissions had a red flag for a MSK examination.
Not a single patient who needed a MSK examination on initial assessment or first review had a full MSK examination documented. In comparison 80% of patients routinely had a respiratory and cardiovascular examinations documented on initial assessment.
Only 1 out of 105 patients who had a red flag for a MSK examination had a complete examination documented.
Conclusions In 2004 the musculoskeletal examination was shown to be poorly documented.2 This audit shows that the musculoskeletal examination is still rarely being documented across Yorkshire, across disciplines, by doctors at all levels, even when there are clear triggers and red flags for the examination.
We propose a change in the admission documentation regionally to include a specific MSK section for acute admissions.
We plan educational events in the region to improve knowledge of MSK examination.
We plan to re-audit in the region, following the introduction of this intervention.
We propose a national audit should be performed. then more educational measures, directed at all levels of doctors should be driven forward, on a national level, to ensure that this picture improves.
pGALS- A screening examination of the musculoskeletal system in school aged children, Foster HE, Jan dial S, ‘Hands On’, Reports on the Rheumatic Diseases Series 5, Number 15, June 2008.
Rheumatology (Oxford). 2004 Aug; 43(8):1045–9. EPub 2004 Jun 8. More ‘cries from the joints’: assessment of the musculoskeletal system is poorly documented in routine paediatric clerking. Goff I, Bateman B, Myers A, Foster H