105 - Epidemiology of preschool age children presenting to the Orthopedic Clinic with Limping

Poster Number: 105
Publication Number: 105.409

Megan M. Hannon, Boston Children's Hospital, Pembroke, MA, United States; Lois K. Lee, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Blair Stewig, Boston Children's Hospital, Brighton, MA, United States

Background: Limping in preschool age children is a common chief complaint in the orthopedic clinic. There is variability in the evaluation of these patients as many causes are benign; however, serious causes, including from infections, are often considered.

Objective: The objectives of this study are to describe the epidemiology of preschool age children presenting with limp and to determine predictors identifying those children at risk for non- benign etiologies.

Design/Methods: This is a retrospective study of children < 6 years old presenting to a tertiary care pediatric orthopedic clinic with a chief complaint of limping from 1/1/2009-12/31/2020. Subjects were identified from the electronic medical record using natural language processing. Exclusion criteria included: limp > 3 weeks, lower extremity fracture or surgery < 12 weeks, or chronic conditions affecting the lower extremity (ie. malignancy, neuromuscular disorder, sickle cell disease). Outcome diagnoses were classified as “benign,” “receiving advanced treatment (i.e. antibiotics, steroids, surgery)” or “inconclusive.” Proportions of patients for each outcome was calculated and compared using the Chi-squared test. Bivariate analyses were conducted using Student’s t-test, the Mann-Whitney U-test, or chi-squared test. We conducted a multivariable logistic regression analysis to determine predictors associated with the outcome of receiving advanced treatment vs benign/inconclusive diagnoses, while controlling for patient characteristics.  

Results: We identified 169 children < 6 years old with limping: 105 with benign causes (62), 27 receiving advanced treatment (16%), and 37 inconclusive diagnoses (22%). The most common diagnoses among those receiving advanced treatment were juvenile idiopathic arthritis (8/27, 30%) and Lyme disease (7/27, 26%) (Table 1). On bivariate analysis increased odds for requiring advanced treatment was identified for females (OR 2.8, 95% CI 1.20, 6.44) and joint edema on exam (OR 5.3, 95% CI 2.11, 13.47) (Table 2). Multivariate logistic regression found increased odds for receiving advanced treatment for females (OR 3.05, 95% CI 1.13, 8.24), joint edema (4.49, 95% CI 1.48, 13.61), and limp > 9 days (OR 3.43, 95% CI 1.24, 9.51).Conclusion(s): The majority of preschool age children presenting with limp had a benign diagnosis. Understanding predictors for causes of limping receiving advanced treatment may decrease variability in the evaluation of children with limping.