Original Article
Acceptability and Practicality of Musculoskeletal Examination in Acute General Pediatric Assessment

https://doi.org/10.1016/j.jpeds.2009.10.047Get rights and content

Objective

To evaluate the practicality and the acceptability of pGALS (pediatric Gait, Arms, Legs and Spine) screening, a simple pediatric musculoskeletal screening examination, when performed as part of an acute pediatric assessment.

Study design

Consecutive school-aged children attending an acute pediatric assessment unit were assessed with the addition of pGALS to the routine clinical examination. Practicality (ie, time taken, degree of completion) and patients/parent-assessed acceptability (ie, time taken, discomfort caused) were recorded.

Results

Fifty consecutive school-aged children (median age 8 years) were evaluated by pGALS. Median time taken was 3 minutes (range 1.2-5.3), and examination was completed in 47/50 (96%) children. Acceptability of pGALS was deemed high: time taken was “about right” (98% children, 94% parents) and caused no or little discomfort (72% of children, 92% of parents). Abnormalities on pGALS examination were common, with most (17/50, 34%) explained by confirmed musculoskeletal disease, and 6 of 50 (12%) had non- musculoskeletal disease.

Conclusions

PGALS is practical and acceptable to perform in acute pediatric assessment performed by a non expert in musculoskeletal medicine. Abnormal musculoskeletal findings are common as part of the pGALS examination but need to be interpreted in the global clinical context and 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 (0)

    The authors declare no conflicts of interest.

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