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Paediatric acute non-traumatic limp presenting to the emergency department: a retrospective observational study
  1. Jacky Tu1,2,
  2. Mitchell Haines1,3,
  3. Peter Gowdie3,4,
  4. Simon Craig3,5
  1. 1School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  2. 2Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  3. 3Department of Paediatrics, Monash University, Clayton, Victoria, Australia
  4. 4Department of Paediatrics and Department of Paediatric Rheumatology, Monash Children's Hospital, Clayton, Victoria, Australia
  5. 5Paediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
  1. Correspondence to Dr Simon Craig, Monash Medical Centre Clayton, Clayton 71326, Victoria, Australia; simon.craig{at}monash.edu

Abstract

Background Acute non-traumatic limp in children has many causes, ranging from common benign and self-limiting disease to serious time-sensitive emergencies such as septic arthritis. We aimed to (1) describe the epidemiology and workup of paediatric acute non-traumatic limp presentation in three Australian EDs and (2) compare investigations and treatment between a tertiary paediatric centre and two non-tertiary centres.

Methods A retrospective chart review of children aged 0–16 years, with an initial presentation of non-traumatic limp to three EDs in Melbourne, Australia. Data on presentation, management and outcomes was systematically collected on all eligible patients.

Results Of 63 941 presentations over a 12-month period, 475 (0.7%) met inclusion criteria. The median (IQR) age of presentation was 5 (3–8) years, with a male predominance (61%). Blood tests and imaging were performed in 39% and 51%, respectively. 34% of presentations had no investigations. The most frequent ED diagnoses were transient synovitis (37%) and viral myositis (16%). 84% were discharged home after ED evaluation. Compared with the two non-tertiary hospitals, children who presented to the tertiary centre were less likely to have any investigation performed (OR=0.41, 95% CI: 0.27 to 0.62, p<0.001) and more likely to be discharged home after evaluation (OR=4.67, 95% CI: 2.79 to 7.81, p<0.001).

Conclusion Although mostly due to benign disorders, an important number of limping children who presented to the ED had serious disease, with approximately one-third of these not diagnosed at the initial ED visit. There is large variation in workup including blood test, imaging and decisions regarding ED disposition.

  • pediatric emergency medicine
  • epidemiology
  • epidemiology

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Handling editor Steve Rothrock

  • Contributors SC, JT and PG conceived the study. JT collected the data, supervised by SC and PG. MH wrote the first draft of the paper. All authors have reviewed the final draft and approve submission.SC accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.