Acceptability and practicality of musculoskeletal examination in acute general pediatric assessment

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.