Acute non-traumatic hip pathology in children: incidence and presentation in family practice

Abstract

Background: The differential diagnosis of children with acute non-traumatic hip pathology varies from quite harmless conditions such as transient synovitis of the hip to more severe problems like Perthes' disease, slipped capital femoral epiphysis (SCFE) and life-threatening conditions such as septic arthritis of the hip.

Objective: To provide population-based data on symptom presentation and incidence rates of non-traumatic acute hip pathology in family practice.

Methods: We analysed data from a large national survey of family practice (104 practices), which was carried out by the Netherlands Institute for Health Services Research (NIVEL) in 2001. We included all children aged 0-14 years. Incidence rates were calculated by dividing the total number of cases (numerator) by the average study population at risk (denominator).

Results: Our study population consisted of 73 954 children aged 0-14 years, yielding 68 202 person-years. These children presented with 101 episodes of acute non-traumatic hip pathology. The presenting feature in 81.5% of the children was pain, in 8.6% limping and 9.9% presented with both symptoms. Only 27% of the participating family practitioners (FPs) reported whether the child had a fever. The incidence rate for all acute non-traumatic hip pathology was 148.1 per 100 000 person-years, and for transient synovitis, this was 76.2 per 100 000 person-years.

Conclusion: In family practice, most children with acute non-traumatic hip pathology present with pain as the initial symptom. FPs need to be more aware that fever is the main distinguishing factor between a harmless condition and a life-threatening condition. Transient synovitis is the diagnosis with the highest incidence rate.