Department of Orthopaedics and Rehabilitation, Penn State College of Medicine.
WLH: Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, Pennsylvania, USA.
J Pediatr Orthop B. 2022 Nov 1;31(6):613-618. doi: 10.1097/BPB.0000000000000979. Epub 2022 May 24.
In 2004, Reeder and in 2012, Schwend reported that inappropriate nonsurgical referrals to pediatric orthopedic clinics create a misuse of resources. Additional authors have called for re-emphasis and additional training in musculoskeletal medicine for primary care physicians (PCP) to improve the confidence, knowledge and performance when managing musculoskeletal conditions. The current study compares the diagnoses referred to a pediatric orthopedic clinic with diagnoses recommended for referral by the American Academy of Pediatrics (AAP) guidelines to determine if any improvement in the quality of referrals has occurred since Reeder and Schwend's article. A chart review of new referrals to a pediatric orthopedic clinic during a 3-month-period was performed. Data were collected on age, sex, referring diagnosis, referral source, final diagnosis and treatment. In total 230 new consults were evaluated. The referral source was a PCP in 169 (73.5%) cases, 30 (13%) self-referrals by a parent, 19 (8.3%) from another orthopedic surgeon, 9 (3.9%) from a neurologist and 3 (1.3%) from another specialist. Fifty percent of referrals met the criteria outlined in the AAP guidelines for referral to a pediatric orthopedic specialist and 48% were classified as primary care musculoskeletal conditions. During the 15 years since the publication of Reeder's study and despite a limited re-emphasis on musculoskeletal education, the percent of inappropriate referrals to a pediatric orthopedic clinic remains unchanged at 50%. We support an expanded musculoskeletal educational effort aimed at the medical, resident and pediatrician level, online decision-making aids, and implementation of a standardized referral form with the specific criteria of the AAP included.
2004 年，Reeder 和 2012 年，Schwend 报道称，不适当的非手术转诊至小儿矫形诊所造成了资源的滥用。其他作者呼吁重新强调和加强初级保健医生（PCP）在肌肉骨骼医学方面的培训，以提高他们在管理肌肉骨骼疾病时的信心、知识和技能。本研究比较了转诊至小儿矫形诊所的诊断与美国儿科学会（AAP）指南推荐的转诊诊断，以确定自 Reeder 和 Schwend 的文章发表以来，转诊质量是否有所提高。对小儿矫形诊所 3 个月期间的新转诊患者进行了图表回顾。收集了年龄、性别、转诊诊断、转诊来源、最终诊断和治疗的数据。共评估了 230 例新转诊患者。转诊来源为 PCP 的有 169 例（73.5%），30 例（13%）为家长自行转诊，19 例（8.3%）来自另一位矫形外科医生，9 例（3.9%）来自神经科医生，3 例（1.3%）来自其他专科医生。有 50%的转诊符合 AAP 指南中转诊至小儿矫形专家的标准，48%的转诊被归类为初级保健肌肉骨骼疾病。自 Reeder 研究发表以来的 15 年中，尽管对肌肉骨骼教育的重视程度有限，但转诊至小儿矫形诊所的不适当转诊比例仍保持在 50%不变。我们支持针对医疗、住院医师和儿科医生的扩展肌肉骨骼教育工作、在线决策辅助工具，以及实施包含 AAP 具体标准的标准化转诊表格。
