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Klin Padiatr 2014; 226(02): 86-98
DOI: 10.1055/s-0034-1366989
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© Georg Thieme Verlag KG Stuttgart · New York

Musculoskeletal Pain: A New Algorithm for Differential Diagnosis of a Cardinal Symptom in Pediatrics

Muskuloskelettale Schmerzen: Neuer Algorithmus zur differenzialdiagnostischen Evaluation eines Leitsymptoms in der Pädiatrie
G. Tallen
1   Department of Pediatric Oncology/Hematology, Charite-Medical School, Berlin, Germany
,
S. Bielack
2   Children’s Hospital Stuttgart, “Pediatrics 5”, – Olgahospital, Stuttgart, Germany
,
G. Henze
3   Department of Pediatric Oncology/Hematology, Charite-Medical School, Berlin, Germany
,
G. Horneff
4   Department of Pediatrics, Asklepios Hospital, Sankt Augustin, Germany
,
R. Korinthenberg
5   Department of Pediatric Neurology and Muscle Diseases, Children’s ­Hospital Freiburg, Freiburg-Medical School, Freiburg, Germany
,
B. Lawrenz
6   Pediatrician, Arnsberg, Germany
,
T. Niehues
7   Department of Pediatrics, HELIOS Clinics Krefeld, Krefeld, Germany
,
J. Peitz
8   Department of Pediatics, University Hospital Cologne, Cologne, Germany
,
R. Placzek
9   Department of Pediatric Orthopedics and Neuroorthopedics, University Hospital Bonn, Bonn, Germany
,
P. Schmittenbecher
10   Department of Pediatric Surgery, Hospital Karlsruhe, Karlsruhe, Germany
,
E. Schönau
11   Department of General Pediatrics, University Hospital Cologne, Cologne, Germany
,
L. Wessel
12   Department of Pediatrics, Heidelberg Medical School/Hospital Mannheim, Mannheim, Germany
,
T. Wirth
13   Department of Pediatrics/Division of Pediatric Orthopedics, Hospital ­Stuttgart, Stuttgart, Germany
,
H.-J. Mentzel
14   Department of Pediatric Radiology, Jena University Hospital, Jena, Germany
,
U. Creutzig
15   Department of Pediatric Hematology and Oncology, Medical High School Hanover, Hanover
› Author Affiliations
Further Information

Publication History

Publication Date:
31 March 2014 (online)

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Abstract

Musculoskeletal pain (MSP) is a common childhood complaint associated with multiple differential diagnoses, including cancer. Considering the expanding spectrum of diagnostics, evaluat­ing a young patient with MSP is a challenge today, particularly for non-specialists in a primary care setting. Since childhood cancer is rare and most cardinal symptoms mimic rather non-serious diseases, misdiagnosis is not uncommon, but of significant prognostic relevance. To build the appropriate bridge between primary and secon­dary care for a child presenting with MSP, thereby preventing treatment delay and longterm sequelae, initial evaluation should follow a comprehensive, multidisciplinary, systematic and stepwise approach, which unites the patient’s individual anamnestic, psychosocial, and clinical charac­teristics. After a systematic review of the literature, we generated multidisciplinarily quality-assured recommendations for efficient, rational and cost-effective primary care assessment of pediatric MSP. The algorithm promotes the identification and structured interpretation of the patient’s individual clinical clues. It should serve the primary care physician to recognize when further intervention, rather than reassurance and follow-up, is needed using the minimum amount of testing to make an appropriate, prompt diagnosis in the clinical situation “child presenting with MSP”. A German version of this algorithm has been published in the Guideline-Portal of The Association of the Scientific Medical Societies (“Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften”, AWMF) in November 2013.

Zusammenfassung

Muskuloskelettale Schmerzen (MSS) sind bei Kindern und Jugendlichen häufig und mit einem breiten Spektrum an Differenzialdiagnosen, auch Krebs, assoziiert. Durch kontinuierliche Optimierung von Diagnostik und Behandlung wurden die Überlebensraten von Kindern und Jugendlichen mit Krebserkrankungen in den letzten Jahrzehnten auf über 80% gesteigert. Für die erstversorgenden Ärzte tritt ein gezielter, kostenbewusster Umgang mit den diagnostischen Verfahren zunehmend in den Vordergrund. Aufgrund der Seltenheit von Krebs bei Kindern und Jugendlichen wird bei unspezifischen Symptomen wie MSS oft nicht gleich an ein Malignom als Ursache gedacht. So kommt es einerseits regelmäßig zu Fehldiagnosen mit prognostischer Relevanz. Andererseits belastet unnötige invasive und kostspielige Diagnostik sowohl die Patienten als auch das Gesundheitssystem. Ziel dieser Übersichtsarbeit ist die Verbreitung eines Algorithmus zur symptomorientierten Differenzialdiagnostik in der Situation „Kind/Jugendliche(r) mit MSS“ in der Primärversorgung. Damit soll zur Verbesserung der Prognose von Kindern und Jugendlichen mit MSS und entsprechender Grunderkrankung beigetragen werden. Der Algorithmus wurde von Mitgliedern der Gesellschaft Pädiatrische Onkologie und Hämatologie (GPOH) in Zusammenarbeit mit der Deutschen Gesellschaft für Kinder- und Jugend­medizin (DGKJ) und dem Bundesverband für Kinder- und Jugendmedizin (BVKJ) entwickelt. Es wird eine Vorgehensweise zur sofortigen und richtigen Diagnosestellung empfohlen, die die individuelle anamnestische, psychosoziale und klinische Befundkonstellation des Patienten systematisch erfasst und schrittweise miteinander vereinigt.

Key words

children and adolescents - musculoskeletal pain - epidemiology - etiology - differential diagnosis - primary care

Schlüsselwörter

Kinder und Jugendliche - muskuloskelettale Schmerzen - Epidemiologie - Ätiologie - Differenzialdiagnose - Primärdiagnostik
 

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