Fallatah Salah, Felemban Mehad, Farran Abrar, Alharbi Lina, Borgola Safwan
Department of Orthopedics, Faculty of Medicine, Umm Al-Qura University, Makkah, KSA.
Orthopaedic Specialty Clinic, Jeddah, KSA.
J Taibah Univ Med Sci. 2018 May 19;13(4):338-343. doi: 10.1016/j.jtumed.2018.04.008. eCollection 2018 Aug.
Most paediatric orthopaedic problems referred to paediatric orthopaedists are usually self-limited, requiring observation and reassurance. Higher parental expectations may have resulted in higher referral rates. This study was conducted to assess awareness and knowledge about the diagnosis and management of some common normal variants of musculoskeletal paediatric development among paediatricians and primary health care physicians.
A self-administered questionnaire (tested for validity and reliability) was distributed between November 2016 and June 2017. Of 300 questionnaires, 189 (63% response rate) were obtained from 106 paediatricians, 57 family physicians, and 26 general practitioners (GPs).
Paediatricians accounted for 56% of participants, 30.2% were family physicians, and 13.8% were GPs. Correct answer rates ranged between 9% and 66.1%. Inadequate knowledge of common paediatric orthopaedic problems was found in 87.3% of participants. With parental insistence, 75.7% of physicians referred a case, regardless of necessity, whereas inappropriate referral for medicolegal issues was reported by 62.4%. The study showed that paediatricians were less likely than family physicians and GPs to refer inappropriately (67% versus 87.7% and 84.6%, respectively; p = 0.007). Physicians who reported that more than 10% of their training was in orthopaedics were more likely to inappropriately refer orthopaedic cases compared to those who reported a higher percentage of orthopaedic training (82.1% versus 66.7%).
Inappropriate paediatric orthopaedic referrals are increasing. The results clearly point to the need for increased musculoskeletal education during undergraduate medical and residency training in paediatrics and family medicine. New guidelines should be implemented and updated regularly. Educational material for parents (posters, videos, etc.) should be considered.
大多数转诊给小儿骨科医生的儿科骨科问题通常是自限性的，需要观察和安抚。较高的家长期望可能导致了较高的转诊率。本研究旨在评估儿科医生和基层医疗医生对小儿肌肉骨骼发育一些常见正常变异的诊断和管理的认识与知识。
2016年11月至2017年6月发放了一份自填式问卷（经过效度和信度测试）。在300份问卷中，从106名儿科医生、57名家庭医生和26名全科医生（GPs）处获得了189份（回复率63%）。
参与者中儿科医生占56%，家庭医生占30.2%，全科医生占13.8%。正确答案率在9%至66.1%之间。87.3%的参与者对常见儿科骨科问题的知识掌握不足。在家长坚持下，75.7%的医生无论有无必要都转诊了病例，而62.4%的医生报告因法律问题进行了不恰当转诊。研究表明，儿科医生比家庭医生和全科医生进行不恰当转诊的可能性更小（分别为67%、87.7%和84.6%；p = 0.007）。报告称其培训中超过10%是骨科培训的医生比报告骨科培训比例更高的医生更有可能不恰当地转诊骨科病例（82.1%对66.7%）。
不恰当的儿科骨科转诊正在增加。结果明确指出，在儿科和家庭医学的本科医学教育和住院医师培训期间，需要加强肌肉骨骼方面的教育。应实施并定期更新新指南。应考虑为家长提供教育材料（海报、视频等）。
