Rheumatology Advance Access originally published online on June 8, 2004
Rheumatology 2004 43(8):1045-1049; doi:10.1093/rheumatology/keh245
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rheumatology Vol. 43 No. 8 © British Society for Rheumatology 2004; all rights reserved
Paper |
More ‘cries from the joints’: assessment of the musculoskeletal system is poorly documented in routine paediatric clerking
1 Departments of Rheumatology and 2 Child Health, University of Newcastle upon Tyne, 3 Institute of Child Health, University of Birmingham, 4 Birmingham Children's Hospital, 5 Rheumatology, Queen Alexandra Hospital, Portsmouth, 6 Paediatrics, St Mary's Hospital, Portsmouth and 7 Rheumatology, Newcastle Hospitals NHS Trust, UK.
Correspondence to: A. Myers. E-mail: andrea.myers{at}ncl.ac.uk
Objectives. The aim of this study was to describe the assessment of the musculoskeletal (MSK) system in comparison with other systems in routine paediatric medical clerking. Furthermore, to survey trainee paediatricians (SPRs, specialist registrars) about their self-rated confidence in assessing the MSK system.
Methods. Case notes of consecutive general paediatric medical patients admitted to three UK hospitals over a 4-week period were assessed using a standard pro forma. All patients had been assessed by a consultant paediatrician during their admission. A postal questionnaire was sent to all SPRs in training in each of the hospitals, regarding their confidence in assessing the MSK system compared with other systems and their exposure to MSK teaching.
Results. Case notes of 257 patients [117 females, median age 3 yr (range 1–18 yr)] were reviewed. The most common reason for admission was acute infection, although the spectrum of other recorded diagnoses varied between hospitals. Thirteen children (5%) had an acute problem (e.g. infection) against a background of chronic disease. The case note documentation showed that cardiovascular (CVS), respiratory (RS) and gastrointestinal (GI) systems were assessed in the vast majority (>90%) of patients, irrespective of the underlying diagnosis. However, other systems were less well recorded; the trend being the same in each hospital and in descending order, the neurological system (38%), skin (32%), eyes (10%) and musculoskeletal system (4%). Only 2.7% (7/257) patients were documented to have been asked about MSK symptoms, and only 1.6% (4/257) had any documentation of joint examination—in all cases this was limited (e.g. range of movement of the knee only), and no patients had documentation of gait being examined, even in those children presenting with ‘limp’. The response rate to the postal questionnaire was 60% (67/112). The self-rated confidence in MSK assessment was markedly low in comparison with other systems, even though 61/67 recalled some teaching of the MSK system as an undergraduate (61/67) or postgraduate (50/67). Of note none could recall teaching as an undergraduate in paediatric MSK assessment and where there had been postgraduate rheumatology MSK teaching this had been delivered by paediatric rheumatologists in many cases (34/50), reflecting the centres participating in the study.
Conclusions. In routine general paediatric medical in-patient clerking and throughout the admission, MSK assessment was rarely documented, and even where present was limited. This contrasts markedly with other systems which were examined in most children irrespective of the presenting complaint. Self-rated confidence in MSK assessment is low amongst SPRs compared with other systems, despite most recalling some teaching. This discrepancy between teaching and clinical practice needs to be addressed in undergraduate and postgraduate training.
KEY WORDS: Juvenile idiopathic arthritis, Juvenile rheumatoid arthritis, Medical record, Documentation, History and physical examination, Education, Musculoskeletal system
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  N. Adib, K. Hyrich, J. Thornton, M. Lunt, J. Davidson, J. Gardner-Medwin, H. Foster, E. Baildam, L. Wedderburn, and W. Thomson Association between duration of symptoms and severity of disease at first presentation to paediatric rheumatology: results from the Childhood Arthritis Prospective Study Rheumatology, July 1, 2008; 47(7): 991 - 995. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Ehrmann Feldman, S. Bernatsky, M. Abrahamowicz, Y. Roy, Y. Xiao, J. Haggerty, K. Leffondre, P. Tousignant, and C. M. Duffy Consultation With an Arthritis Specialist for Children With Suspected Juvenile Rheumatoid Arthritis: A Population-Based Study Arch Pediatr Adolesc Med, June 1, 2008; 162(6): 538 - 543. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. E. Foster, S. Everett, and A. Myers Rheumatology training in the UK: the trainees' perspective Rheumatology, February 1, 2005; 44(2): 263 - 264. [Full Text] [PDF]
|
|
|
|
|
|
S. G. Dubey, C. Roberts, and A. O. Adebajo Rheumatology training in the UK: the trainees' perspective - issues surrounding paediatric rheumatology Rheumatology, February 1, 2005; 44(2): 264 - 264. [Full Text] [PDF]
|
|