Musculoskeletal conditions in children and adolescents managed in Australian primary care.

Nicholas Henschke,Christopher G Maher,Christopher Harrison,Jane Latimer,Damien Mckay,Carolyn Broderick,Helena Britt

doi:10.1186/1471-2474-15-164

Abstract

BackgroundPrimary care settings play a vital role in the early detection and appropriate management of musculoskeletal conditions in paediatric populations. However, little data exist regarding these conditions in a primary care context or on the presentation of specific musculoskeletal disorders in children. The aim of this study was to estimate the caseload and describe typical management of musculoskeletal conditions in children and adolescents presenting to primary care in Australia.MethodsAn analysis of data from the Bettering the Evaluation and Care of Health (BEACH) study was performed. The BEACH study is a continuous national study of general practice (GP) activity in Australia. We identified all GP encounters with children and adolescents over the past five years and extracted data on demographic details, the problems managed, and GP management of each problem. SAS statistical software was used to calculate robust proportions and after adjustment for the cluster, the 95% confidence intervals (CIs).ResultsFrom the period April 2006 to March 2011, there were 65,279 encounters with children and adolescents in the BEACH database. Of the 77,830 problems managed at these encounters, 4.9% (95%CI 4.7% to 5.1%) were musculoskeletal problems. The rate of musculoskeletal problems managed increased significantly with age, however there was a significant decrease for girls aged 15–17 years. Upper and lower limb conditions were the most common, followed by spine and trunk conditions. Spine and trunk conditions were significantly more likely to be managed with medication, but less likely to receive imaging, than upper or lower limb problems.ConclusionsMusculoskeletal problems in children and adolescents present a significant burden and an important challenge to the primary health care system in Australia. There is variability in rates of presentation between different age groups, gender and affected body region.

Highlights

Primary care settings play a vital role in the early detection and appropriate management of musculoskeletal conditions in paediatric populations
Participants We identified all general practitioner (GP) encounters with children and adolescents aged less than 18 years recorded from April 2006 to March 2011 and identified those involving management of one or more musculoskeletal problems
Musculoskeletal problems (n = 3,815) were the sixth most common type of problem managed in children and adolescents, accounting for 4.9% of all problems, and managed at a rate of 5.8 per 100 encounters

Summary

Introduction

Primary care settings play a vital role in the early detection and appropriate management of musculoskeletal conditions in paediatric populations. The aim of this study was to estimate the caseload and describe typical management of musculoskeletal conditions in children and adolescents presenting to primary care in Australia. Primary care settings play a vital role in the early detection and appropriate management of inflammatory and non-inflammatory musculoskeletal conditions in paediatric populations. In one of the only studies carried out in a primary care setting (in Spain), the prevalence of musculoskeletal pain was estimated to increase from 3% at the age of 3 years to 30% by age 14. This study reported that musculoskeletal pain is responsible for approximately 6% of the primary care visits of children between 3 and 14 years of age, and more than 10% of visits by adolescents [8]. A further investigation showed that musculoskeletal problems (including fracture, sprain and strain) were more likely to be managed in adolescent (12–18 years) boys than in girls [10]

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