Early diagnostic procedures in primary care and hospital for children with a painful hip. A prospective study.

Objectives: To evaluate the current practice in the approach to the painful hip in children. To determine the superiority of ultrasonographic techniques over plain X-ray and to provide guidance to primary care.

Methods: We carried out a prospective cohort study of 55 patients with a painful hip. The management leading up to admission and diagnostic procedures were examined. We carried out ultrasound of all affected hips and repeated the scan every three days. Effusion on ultrasound was noted and was correlated to the symptoms.

Results: In total 29/55 patients had plain X-rays taken before or at the initial presentation. No abnormalities were found. Ultrasound showed effusion in 48/55 children. The reduction of the effusion correlated with the improvement in symptoms. An effusion persisting longer than 26 days correlated well to those patients who went on to be diagnosed with a chronic condition (3/4 patients).

Conclusions: At present many practitioners use plain X-ray in the initial diagnosis. Ultrasound should be the initial diagnostic tool of choice. Repeat ultrasound at one month may be of use to determine if the child is likely to develop a chronic condition.