Poor sensitivity of musculoskeletal history in children

Abstract

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.