Original ArticleAcceptability and Practicality of Musculoskeletal Examination in Acute General Pediatric Assessment
Section snippets
Methods
The Children's Assessment Unit (CAU) at North Tyneside General Hospital, Northumbria NHS Trust, receives more than 2000 children per year with referrals from general practitioners directly or via the hospital accident and emergency department and operates every day from 8 am to 10 pm. Fewer than 5% of children are admitted outside these hours, and these are assessed on the inpatient unit. On the CAU, children are assessed by doctors working in general pediatrics under the supervision of
Results
Table I shows the presenting complaints of the children assessed in the study. Over the study period a total of 762 children were assessed on the CAU of which 231/762 (30%) were eligible by age (4-15 years). The aim was to recruit 50 children among consecutive eligible children presenting assessed by another on-call pediatric doctor. All but four of those approached agreed to take part with reasons for nonparticipation given as child too tired (n = 1), child being upset (n = 2), and family
Discussion
This study demonstrates that pGALS can be performed in an acute pediatric scenario by a nonexpert in musculoskeletal medicine and is acceptable to both parents and children. This important finding supports the use of pGALS as a core clinical skill in routine pediatric clinical practice. Furthermore, this work addresses a limitation of the original validation of pGALS, which was performed in a tertiary pediatric rheumatology setting, in the hands of an experienced rheumatologist reviewing
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Cited by (37)
A survey of knowledge, attitudes, and practices relating to musculoskeletal examination among pediatricians in Maharashtra, India
2015, Indian Journal of RheumatologyCitation Excerpt :However, while pediatric musculoskeletal (pMSK) disorders are common in clinical practice, MSKe is a neglected clinical skill, which may contribute to the delayed or missed rheumatologic diagnosis in CYP.6–8 pMSK problems often present with vague, poorly localized symptoms, and evidence demonstrates that taking the history alone fails to signpost to the extent of joint involvement.9–11 It is therefore recommended that all CYP presenting symptoms of possible MSK disease undergo a ‘top-to-toe’ MSKe such as the pGALS (Pediatric Gait Arms Legs Spine) assessment.9
The child with joint pain in primary care
2014, Best Practice and Research: Clinical RheumatologyCitation Excerpt :A simple and quick screening examination of the MSK system in children based on the adult Gait, Arms, Legs and Spine (GALS) has been developed, and it is called paediatric GALS (pGALS) [26,27]. This is increasingly being taught at medical schools, and it has been shown to be practicable and accepted by families in developed and developing countries [28,29]. It is recommended as the initial assessment in any child with MSK symptoms in the history; children who are unwell with pyrexia, with delay or regression of motor milestones, and are ‘clumsy’ in the absence of neurological disease; and those with a chronic disease with known association with MSK presentations [27].
Chronic arthritis in children and young people
2014, Medicine (United Kingdom)Citation Excerpt :Free educational resources to demonstrate pGALS are available (http://www.arthritisresearchuk.org/health-professionals-and-students/video-resources/pgals.aspx). pGALS is acceptable in acute paediatric settings,7 and is an effective way to assess all joints. It is useful in the context of vague presentations such as leg pains or limp.
The authors declare no conflicts of interest.