Non-traumatic pediatric orthopaedic referrals in Manitoba.

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Date
2012-11-23
Authors
Sprange, Ashleigh
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Abstract
Musculoskeletal problems account for 20-30% of pediatric medical problems. Forty to 65% of referrals to pediatric orthopaedic surgeons (POS) involve common conditions that could be diagnoses and managed by primary health care providers. The American Academy of Pediatrics Surgical Advisory Panel (AAPSAP) published guidelines for making referrals to pediatric specialists. There are no equivalent guidelines in Canada and there are no published studies regarding referral patterns to POSs in Canada. We wanted to quantify the frequency and trends of unnecessary referrals made to the Section of Pediatric Orthopaedic Surgery (SPOS) at the Children's Hospital of Winnipeg. The AAPSAP referral guidelines were used to determine the appropriateness of the referrals. The X2 test was used to compare categorical variables. Statistical significance was set at P<0.05. We found that 499 (73.4%) of the referrals were unnecessary. The majority of referrals were from general practitioners (47.4%) and pediatricians (30%). The greatest rate of unnecessary referrals came from the eastern-interlake region (87.9 per 100 cases referred) and the southern region (84.4) of Manitoba. Torsional variations (98.4), musculoskeletal pain/overuse injuries (94.3), angular variations (89.9) and idiopathic scoliosis (88.1) accounted for the conditions with the greatest rate of unnecessary referrals. Not only is there a significant number of unnecessary non-trauma pediatric orthopaedic referrals to the SPOS, but there appears to be a predictable patter of unnecessary referrals. This emphasizes the importance of developing and implementing a set of Canadian pediatric orthopaedic referral guidelines.
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Medicine
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