title: Acute non-traumatic hip pathology in children: incidence and presentation in family practice.
abstract: BACKGROUND
  The differential diagnosis of children with acute non-traumatic hip pathology varies from quite harmless conditions such as transient synovitis of the hip to more severe problems like Perthes' disease, slipped capital femoral epiphysis (SCFE) and life-threatening conditions such as septic arthritis of the hip.
  
  
  OBJECTIVE
  To provide population-based data on symptom presentation and incidence rates of non-traumatic acute hip pathology in family practice.
  
  
  METHODS
  We analysed data from a large national survey of family practice (104 practices), which was carried out by the Netherlands Institute for Health Services Research (NIVEL) in 2001. We included all children aged 0-14 years. Incidence rates were calculated by dividing the total number of cases (numerator) by the average study population at risk (denominator).
  
  
  RESULTS
  Our study population consisted of 73 954 children aged 0-14 years, yielding 68 202 person-years. These children presented with 101 episodes of acute non-traumatic hip pathology. The presenting feature in 81.5% of the children was pain, in 8.6% limping and 9.9% presented with both symptoms. Only 27% of the participating family practitioners (FPs) reported whether the child had a fever. The incidence rate for all acute non-traumatic hip pathology was 148.1 per 100 000 person-years, and for transient synovitis, this was 76.2 per 100 000 person-years.
  
  
  CONCLUSIONS
  In family practice, most children with acute non-traumatic hip pathology present with pain as the initial symptom. FPs need to be more aware that fever is the main distinguishing factor between a harmless condition and a life-threatening condition. Transient synovitis is the diagnosis with the highest incidence rate.
authors.affiliation: Department of General Practice, Erasmus MC-University Medical Center Rotterdam, Room Ff304, PO Box 2040, 3000 CA Rotterdam, The Netherlands. m.krul@erasmusmc.nl
authors.forename: Marjolein
authors.initials: M
authors.lastname: Krul
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Lisette W A
authors.initials: LW
authors.lastname: van Suijlekom-Smit
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
mesh_terms: D000208:Acute Disease / Q000453:epidemiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006615:Hip / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010146:Pain