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Acute non-traumatic hip pathology in children: incidence and presentation in family practice

2009; Oxford University Press; Volume: 27; Issue: 2 Linguagem: Inglês

10.1093/fampra/cmp092

1460-2229

Marjolein Krul, Johannes C. van der Wouden, François Schellevis, Lisette W. A. van Suijlekom‐Smit, Bart W. Koes,

Orthopaedic implants and arthroplasty

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.