Variability in physicians' reported ordering and perceived reassurance value of diagnostic tests in children with 'growing pains'
C. Macarthur, J. G. Wright, R. Srivastava, W. Rosser and W. Feldman
Division of General Paediatrics, Hospital for Sick Children, Toronto, Ontario.
OBJECTIVES: To determine the variability in the reported ordering of tests
and treatment and to determine physicians' perceptions of the reassurance
value to families of diagnostic tests in children with "growing pains."
DESIGN: Cross-sectional survey using a mailed questionnaire. SETTINGS:
Primary care and referral practices in Toronto, Ontario. PARTICIPANTS:
University-affiliated primary care pediatricians and family physicians were
surveyed, as well as all pediatric orthopedic surgeons and pediatric
rheumatologists in Ontario. Pediatric orthopedic surgeons and pediatric
rheumatologists were combined into a single group. MAIN OUTCOME MEASURES:
Frequency of office visits because of growing pains, frequency of
diagnostic testing, management strategies for these children, and
physicians' perceptions of the reassurance value of diagnostic tests.
RESULTS: Of 205 eligible physicians, 181 (88.3%) responded. The median
reported frequency of office visits because of growing pains was 1%.
Compared with the other physician groups, family physicians were
significantly more likely to order a determination of the hemoglobin level
(P = .003), erythrocyte sedimentation rate (P = .01), white blood cell
count (P = .01), and differential blood cell count (P = .003), but not
imaging tests. Family physicians were also more likely to order diagnostic
tests when they were under parental pressure to do so (P = .001) or for the
child with repeated visits (P = .02). In total, 86% of pediatric orthopedic
surgeons and pediatric rheumatologists, 95% of pediatricians, and 100% of
family physicians perceived normal test results to be reassuring to
parents. Treatment strategies were similar across the 3 physician groups.
CONCLUSIONS: The frequency of diagnostic testing varied among physician
groups. Virtually all physicians perceived normal test results to be
reassuring to families.
