title: Musculoskeletal pain: a new algorithm for differential diagnosis of a cardinal symptom in pediatrics.
abstract: Musculoskeletal pain (MSP) is a common childhood complaint associated with multiple differential diagnoses, including cancer. Considering the expanding spectrum of diagnostics, evaluat-ing a young patient with MSP is a challenge today, particularly for non-specialists in a primary care setting. Since childhood cancer is rare and most cardinal symptoms mimic rather non-serious diseases, misdiagnosis is not uncommon, but of significant prognostic relevance. To build the appropriate bridge between primary and secon-dary care for a child presenting with MSP, thereby preventing treatment delay and longterm sequelae, initial evaluation should follow a comprehensive, multidisciplinary, systematic and stepwise approach, which unites the patient's individual anamnestic, psychosocial, and clinical charac-teristics. After a systematic review of the literature, we generated multidisciplinarily quality-assured recommendations for efficient, rational and cost-effective primary care assessment of pediatric MSP. The algorithm promotes the identification and structured interpretation of the patient's individual clinical clues. It should serve the primary care physician to recognize when further intervention, rather than reassurance and follow-up, is needed using the minimum amount of testing to make an appropriate, prompt diagnosis in the clinical situation "child presenting with MSP". A German version of this algorithm has been published in the Guideline-Portal of The Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF) in November 2013.
authors.affiliation: Department of Pediatric Oncology/Hematology, Charite-Medical School, Berlin, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Tallen
authors.affiliation: Children's Hospital Stuttgart, "Pediatrics 5", - Olgahospital, Stuttgart, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Bielack
authors.affiliation: Department of Pediatric Oncology/Hematology, Charite-Medical School, Berlin, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Henze
authors.affiliation: Department of Pediatrics, Asklepios Hospital, Sankt Augustin, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Horneff
authors.affiliation: Department of Pediatric Neurology and Muscle Diseases, Children's -Hospital Freiburg, Freiburg-Medical School, Freiburg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Korinthenberg
authors.affiliation: Pediatrician, Arnsberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Lawrenz
authors.affiliation: Department of Pediatrics, HELIOS Clinics Krefeld, Krefeld, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Niehues
authors.affiliation: Department of Pediatics, University Hospital Cologne, Cologne, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Peitz
authors.affiliation: Department of Pediatric Orthopedics and Neuroorthopedics, University Hospital Bonn, Bonn, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Placzek
authors.affiliation: Department of Pediatric Surgery, Hospital Karlsruhe, Karlsruhe, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Schmittenbecher
authors.affiliation: Department of General Pediatrics, University Hospital Cologne, Cologne, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Schönau
authors.affiliation: Department of Pediatrics, Heidelberg Medical School/Hospital Mannheim, Mannheim, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Wessel
authors.affiliation: Department of Pediatrics/Division of Pediatric Orthopedics, Hospital -Stuttgart, Stuttgart, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Wirth
authors.affiliation: Department of Pediatric Radiology, Jena University Hospital, Jena, Germany.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Mentzel
authors.affiliation: Department of Pediatric Hematology and Oncology, Medical High School Hanover, Hanover.
authors.forename: U
authors.initials: U
authors.lastname: Creutzig
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D003299:Cooperative Behavior; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D033183:Interdisciplinary Communication; D008487:Medical History Taking; D059352:Musculoskeletal Pain / Q000209:etiology*; D011320:Primary Health Care