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Poor sensitivity of musculoskeletal history in children


Objectives To demonstrate the sensitivity of musculoskeletal (MSK) history taking.

Design Prospective study: consecutive children attending outpatient clinics.

Setting and patients Paediatric rheumatology clinic (n=45; girls n=28; median age 12 years, range 3–18), acute general paediatric assessment unit (n=50; girls n=21; median age 8 years, range 3–16).

Intervention Pro forma recording abnormal joint involvement from history taking and then following MSK examination completed by clinicians.

Main outcome measures Sensitivity of MSK history taking compared with clinical examination.

Results Paediatric rheumatology clinic: 135 abnormal joints identified in 34 children; 53/135 (39%) by history alone, 82/135 (61%) detected on examination resulting in MSK history sensitivity 53%, specificity 98%. Acute paediatric unit: 29 abnormal joints identified in 17 children; 18/29 identified on history (sensitivity 62%).

Conclusions MSK history taking failed to identify a large number of abnormal joints which were detected on physical examination, emphasising the need for all joints to be examined as part of a screening examination as a minimum.

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