P069 Assessment of diagnostic delay for hip disorders in the pediatric population. (11th November 2021)

• Record Type: Journal Article
• Authors: Ines, Cherif; Triki, Wafa; Hassen, Affes; Ferjani, Hanene; Maatallah, Kaouther; Ben Nessib, Dorra; Kaffel, Dhia; Wafa, Hamdi
• Is Part Of: Rheumatology. Volume 60:Supplement 5(2021)
• Publication Date: 2021-11-11
• Subjects: Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keab722.061
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Background: Hip disorders are highly common among pediatric patients. The diagnosis is based primarily on the clinical findings, the context and the personal and family history of the child. It is in most cases steered by the biological and imaging findings. The latter are usually derived from radiographs, ultrasound imaging and, in some cases, MRI. The main purpose of this study is to evaluate assess the diagnostic delay for hip disorders in the pediatric population. Methods: We conducted a retrospective study including pediatric patients from the rheumatology and the orthopedics department, who consulted or were referred to orthopeadics for a suspected hip disorder. For all patients, we collected the following data: age, clinical findings, imaging findings, the number of consultations in general medicine or emergency medicine and the number of consultations in orthopedics department before the diagnosis is made, the final retained diagnosis and, ultimately, the diagnostic delay since onset of symptoms and first consultation. Results: We included 81 children (48 boys and 33 girls) with a mean age of 9.9 years old [1.5–16]. Sixty-two patients were symptomatic at admission. The pain was located in the hip in 55.5% of patients ( n = 45), in the groin in 7.4% of patients ( n = 6) and in the knee in 12.34% of patients ( n = 10). One child reported unilateral buttock pain. The other reasons for consultation were limping in 3.7% of cases ( n = 3), deformity of the lower limb in 1.23% of cases ( n = 1), a crying baby in 1.23% of cases ( n = 1) and swelling of the knee in 1.23% of cases ( n = 1). On clinical examination, 58 patients had a limitation of the hip motion. Twenty-nine percent of the children had a biological inflammatory syndrome at admission. In total, over one hundred and seventy-one imaging examinations were performed in order to adjust the diagnosis; among them, 7 CT pelvic scan and 23 MRI. The different retained diagnoses of hip involvement are summarized in Table 1 . The mean number of consultations in general medicine or emergency medicine before the diagnosis is made was 0, 58 ranging from 0 to 2. The mean diagnostic delay since the onset of symptoms was 9, 12 months ranging from 3 days to 13 years. The mean diagnostic delay since the first medical check -up was 3, 5 months ranging from 0 to 10 years. Conclusion: Our study showed that the patient lost an average of 9 months from symptom onset to retaining the final diagnosis. The hip being a prognosis joint, this delay could alter the child's future functional abilities.