O2391 SPECIFICITY OF DIAGNOSIS IN PAEDIATRIC BACK PAIN (INITIAL REPORT)

Abstract

Aims: We aim to investigate how often we needed extensive investigations to reach a speciþc diagnosis and whether we could identify symptoms and signs predictive of such diagnosis. Methods: We analysed the records of 60 children referred to our specialist clinics complaining of back pain. We statistically analysed the speciþcity of 9 parameters from history and clinical examination to predict the þnal diagnosis and checked the correlation between initial clinical diagnosis and þnal diagnosis following extensive investigations such as bone scan, CT and MRI scan. Results: The mean age of our group of patients was 12.3 years (range=3–18 years). We failed to reach a speciþc initial diagnosis after history taking, clinical examination and simple X-rays of the spine in 33 patients (55%). By the completion of investigations a speciþc diagnosis was not reached in only 18 (35%), and the difference was signiþcant compared to the other 65% (chi square(1)=4.41, p< 0.05). In 15 children specialist investigations clariþed a diagnosis of spondylolysis, Scheuermannñs disease and tumour. A hypothesised set of 9 clinical symptoms and signs was not predictive of speciþcity of initial clinical diagnosis (RL 2=0.12, chi square (9)=10.07, p> 0.05), but was predictive of þnal diagnosis (RL 2=0.35, chi square(9)=22.88, p< 0.01). A speciþc diagnosis was less likely in the presence of activity related pain or intermittent pain. There was a high degree of correlation between initial clinical diagnosis and þnal diagnosis. (phi=0.70, chi square(1)=25.07, p< 0.001). Conclusions: For about half our group of children, back pain was not a speciþc symptom. A set of common set of clinical symptoms and signs did not initially predict speciþcity. Based on these initial þndings we should continue to investigate in depth any referred child with back pain.