Variability in physicians' reported ordering and perceived reassurance value of diagnostic tests in children with 'growing pains'.

Abstract

To determine the variability in the reported ordering of tests and treatment and to determine physicians' perceptions of the reassurance value to families of diagnostic tests in children with "growing pains." Cross-sectional survey using a mailed questionnaire. Primary care and referral practices in Toronto, Ontario. University-affiliated primary care pediatricians and family physicians were surveyed, as well as all pediatric orthopedic surgeons and pediatric rheumatologists in Ontario. Pediatric orthopedic surgeons and pediatric rheumatologists were combined into a single group. Frequency of office visits because of growing pains, frequency of diagnostic testing, management strategies for these children, and physicians' perceptions of the reassurance value of diagnostic tests. Of 205 eligible physicians, 181 (88.3%) responded. The median reported frequency of office visits because of growing pains was 1%. Compared with the other physician groups, family physicians were significantly more likely to order a determination of the hemoglobin level (P = .003), erythrocyte sedimentation rate (P = .01), white blood cell count (P = .01), and differential blood cell count (P = .003), but not imaging tests. Family physicians were also more likely to order diagnostic tests when they were under parental pressure to do so (P = .001) or for the child with repeated visits (P = .02). In total, 86% of pediatric orthopedic surgeons and pediatric rheumatologists, 95% of pediatricians, and 100% of family physicians perceived normal test results to be reassuring to parents. Treatment strategies were similar across the 3 physician groups. The frequency of diagnostic testing varied among physician groups. Virtually all physicians perceived normal test results to be reassuring to families.