Patterns of musculoskeletal consultations in paediatric patients in primary care over 8 years

Problem

Musculoskeletal pain is a leading cause of morbidity and disability worldwide, and can result in reduced quality of life and increased healthcare costs. Musculoskeletal pain in childhood has been linked with chronic musculoskeletal pain in adulthood. However, few studies have investigated pain trajectories from childhood to adulthood, and no studies have used medical record data to do this.

Our aim was to use primary care consultation data to examine patterns of musculoskeletal consultations over eight years in cohorts of patients initially aged 7-15 years.

Approach

Registration and medical record data from 2003-2010 in patients aged 7-15 years in 2003 was obtained from 11 general practices contributing to the Keele University Consultations in Primary Care Archive.

Analysis included patients who remained registered from 2003 to 2010. Cohorts ranged from the oldest born in 1988 (aged 15-22 years from 2003-2010) to the youngest born in 1996 (aged 7-14 years from 2003-2010). Annual musculoskeletal consultation rates/1000 registered population per age cohort were calculated. Read codes were used to determine reasons for consultation.

Findings

Across all cohorts, 57% of all musculoskeletal consultations were in patients who consulted only once between 2003 and 2010. Those who consulted in two or more years in the eight year period were more likely to consult over consecutive years than sporadically.

Total musculoskeletal consultation rates increased with age in all cohorts, with rates of 76/1000 for 7 year olds up to 276/1000 for 22 year olds. At age 7, males had consultation rates of 66/1000 whilst females had rates of 56/1000. At age 22, males had consultation rates of 148/1000 whilst females had rates of 180/1000.

Within total musculoskeletal consultations, we examined reasons for consultation and observed an increasing rate of consultations for musculoskeletal pain as children aged. Younger cohorts had higher consultation rates for lower limb pain compared with back pain, whereas older cohorts had similar consultation rates for lower limb and back pain.

Consequences

This is the first study examining patterns of musculoskeletal pain in paediatric patients using primary care consultation data.

Our results showed that musculoskeletal consultation rates increased with patient age, with different patterns observed for males and females. We found that musculoskeletal consultations are common in children but the reason for consulting appears to change over time. As children aged, their consultation for a musculoskeletal pain complaint changed from lower limb pain to back pain and lower limb pain.

Future studies should further investigate patterns of consultations for individual patients to determine which paediatric patients may be most likely to develop chronic pain, so that we can identify these patients in primary care and try to intervene to prevent the development of chronic musculoskeletal pain from childhood into adulthood.