-
Views
-
Cite
Cite
Marjolein Krul, Johannes C van der Wouden, François G Schellevis, Lisette W A van Suijlekom-Smit, Bart W Koes, Acute non-traumatic hip pathology in children: incidence and presentation in family practice, Family Practice, Volume 27, Issue 2, April 2010, Pages 166–170, https://doi.org/10.1093/fampra/cmp092
Close - Share Icon Share
Abstract
Background. The differential diagnosis of children with acute non-traumatic hip pathology varies from quite harmless conditions such as transient synovitis of the hip to more severe problems like Perthes’ disease, slipped capital femoral epiphysis (SCFE) and life-threatening conditions such as septic arthritis of the hip.
Objective. To provide population-based data on symptom presentation and incidence rates of non-traumatic acute hip pathology in family practice.
Methods. We analysed data from a large national survey of family practice (104 practices), which was carried out by the Netherlands Institute for Health Services Research (NIVEL) in 2001. We included all children aged 0–14 years. Incidence rates were calculated by dividing the total number of cases (numerator) by the average study population at risk (denominator).
Results. Our study population consisted of 73 954 children aged 0–14 years, yielding 68 202 person-years. These children presented with 101 episodes of acute non-traumatic hip pathology. The presenting feature in 81.5% of the children was pain, in 8.6% limping and 9.9% presented with both symptoms. Only 27% of the participating family practitioners (FPs) reported whether the child had a fever. The incidence rate for all acute non-traumatic hip pathology was 148.1 per 100 000 person-years, and for transient synovitis, this was 76.2 per 100 000 person-years.
Conclusion. In family practice, most children with acute non-traumatic hip pathology present with pain as the initial symptom. FPs need to be more aware that fever is the main distinguishing factor between a harmless condition and a life-threatening condition. Transient synovitis is the diagnosis with the highest incidence rate.
Comments
Dear dr Perry,
Thank you for your carefull reading of our article. I hope I can take your concerns away. We indeed searched on the following keywords; transient, synovitis, Perthes, epiphysis, pain, limp, hip but in the following icpc codes; L02 = back symptom/complaint L13 = hip symptom/complaint L14 = leg/thigh symptom/complaint L15 = knee symptom/complaint L20 = joint symptom/complaint NOS L28 = limited function disability L29 = symptoms/complaints musculoskeletal other L70 = infections musculoskeletal system L88 = rheumatoid/sero-positive arthritis L98 = acquired deformity of limb L99 = musculoskeletal disease other
We therefore expect not to have missed too many children presenting with initial complaints of the knee. A family practitioner, using a icpc coded electronical medical patient record uses symptom codes quite often if diagnosis is not sure yet, slightly different maybe from the way most medical specialist will code. We, family practitioners, will change it into a diagnosis code when diagnosis is sure.
kind regards, Marjolein Krul
Conflict of Interest:
I am the first author of the article
Sir,
We read with interest your article.
We were however surprised at the low numbers of children presenting with knee pain in your series (5.6%).
It is our experience that a significant of proportion of those children presenting with hip pathology initially do so with knee pain.
Is your inclusion algorithm sufficiently sensitive to identify children who present with knee pain and subsequently have a hip pathology? Certainly in the keyword search we note you search on "pain, limp and hip" but not on "knee". Are the low numbers of knee pain therefore a reflection of sampling error? If this were the case then the true incidence of hip pathology would be greater.
Nevertheless, we do not want our comments to detract from what is a welcome contribution to the literature.
Yours faithfully,
Mr Daniel Perry Mr Colin Bruce Orthopaedic Dept Alder Hey Children's Hospital, Liverpool, L12 2AP, UK.
Conflict of Interest:
None declared