Abstract
BACKGROUND: 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. METHOD: 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). RESULTS: 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%). CONCLUSION: 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.