Differential diagnosis in children with musculoskeletal pain in Emergency Department

Drozd, Małgorzata, Gorecka, Adrianna, Zaremba, Bartłomiej, Opoka-Winiarska, Violetta. Differential diagnosis in children with musculoskeletal pain in Emergency Department. Journal of Education, Health and Sport. 2022;12(11):143-153. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2022.12.11.019 https://apcz.umk.pl/JEHS/article/view/40512 https://zenodo.org/record/7262187 The journal has had 40 points in Ministry of Education and Science of Poland parametric evaluation. Annex to the announcement of the Minister of Education and Science of December 21, 2021. No. 32343. Has a Journal's Unique Identifier: 201159. Scientific disciplines assigned: Physical Culture Sciences (Field of Medical sciences and health sciences); Health Sciences (Field of Medical Sciences and Health Sciences). Punkty Ministerialne z 2019 - aktualny rok 40 punktów. Załącznik do komunikatu Ministra Edukacji i Nauki z dnia 21 grudnia 2021 r. Lp. 32343. Posiada Unikatowy Identyfikator Czasopisma: 201159. Przypisane dyscypliny naukowe: Nauki o kulturze fizycznej (Dziedzina nauk medycznych i nauk o zdrowiu); Nauki o zdrowiu (Dziedzina nauk medycznych i nauk o zdrowiu). © The Authors 2022; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 01.10.2022. Revised: 20.10.2022. Accepted: 28.10.2022. Differential diagnosis in children with musculoskeletal pain in Emergency Department Małgorzata Drozd Independent Public Clinical Hospital No. 4 in Lublin, Jaczewskiego 8, 20-954 Lublin https://orcid.org/0000-0002-0710-2451 Adrianna Gorecka Independent Public Clinical Hospital No. 4 in Lublin, Jaczewskiego 8, 20-954 Lublin https://orcid.org/0000-0003-1977-712X Bartłomiej Zaremba Students's Scientific Sociaty at the Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, Gębali 6, 20-093, Lublin, Poland https://orcid.org/0000-0002-3255-2745 Violetta Opoka-Winiarska Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, Gębali 6, 20-093, Lublin https://orcid.org/0000-0003-1644-5568 Abstract Objective: The study was aimed to analyze the diagnostic approach to a child with a non-traumatic musculoskeletal pain registered in the pediatric Hospital Emergency Department (HED). Since the pandemic COVID-19 affects patient health and the healthcare system, we also evaluated the impact of pandemic on type of musculoskeletal symptoms. Study design: A retrospective cross-sectional study was conducted by statistical analysis of data of patients with non-traumatic musculoskeletal pain registered in HED between January 2018 and December 2020. Data of patients referred and not referred to hospital ward and admitted to HED before and during COVID-19 pandemic have been compared. Results: Majority of patients presented acute, non-trauma related, single-site pain, usually localized in the hip, the knee and the spine. 21,49% of patients were referred to a hospital ward, usually rheumatological, neurological or orthopedic. Final diagnoses in almost ¾ patients belong to the group of musculoskeletal system and connective tissue disorders. During the pandemic significantly less patients with musculoskeletal pain reported to our HED. The duration of symptoms before admission was not significantly longer than in previous years, but the problem in children and the impact of the pandemic on the musculoskeletal system in children is complex. Conclusions: Our study provides detailed information on patterns of pediatric musculoskeletal consultations in HED. A positive history of trauma preceding musculoskeletal pain in a child may only be accidentally related to the final cause. Musculoskeletal pain can be also a symptom of a lot of various systemic conditions, not only diseases of the musculoskeletal system. The still ongoing COVID-19 pandemic may require changes in the organization of the HED. We believe that the presented results can help in organizing and planning care in pediatric HEDs, develop diagnostic algorithms and training for HED staff. Key words: musculoskeletal pain; childhood, emergency department, COVID-1