A retrospective study of pediatric rheumatology referrals reveals large discrepancies in referring providers’ musculoskeletal exams
Authors' conclusion
Over half of pediatric rheumatology referrals were attributed to MSK concerns, and one-third of referrals lacked a documented MSK exam, a crucial step in identifying MSK abnormalities.
Study context
- Population
- Pediatric rheumatology referrals, single centre, January 2020 to December 2021
- Participants
- 1,000 referrals
- Exposure
- Referral chief concern (joint pain vs joint swelling) and referring provider musculoskeletal (MSK) exam vs pediatric rheumatologists' final diagnoses and MSK exams
- Outcome
- Descriptive statistics of referrals, concordance between MSK exams, and relationships of chief concern and MSK exams to final diagnosis
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
MSK referrals: chief concern and final diagnosis
P = 0.0012
- MSK referrals among all referrals
- 515
- FDx of NR-MSK
- 28%
- FDx of juvenile idiopathic arthritis (JIA)
- 20%
- No documented referring provider MSK exam
- 33.4%
- Concordance between referring provider and pediatric rheumatologist MSK exams (poor), Kappa
- 0.1035
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Average referral visit costs by final diagnosisFDx JIA vs FDx NR-MSK | P < 0.001 |
- Average referral visit costs by final diagnosis — FDx NR-MSK, average cost
- $2,144
- Average referral visit costs by final diagnosis — FDx JIA, average cost
- $3,298
Original publication
A retrospective study of pediatric rheumatology referrals reveals large discrepancies in referring providers’ musculoskeletal exams. Pediatr Rheumatol Online J. Published 16 January 2026. doi:10.
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