Back pain in children can be a serious condition caused by bone deformity, tumors, or scoliosis (curvature of the spine). Doctors want to make an accurate diagnosis without unnecessary X-rays, worry, and expense. In this article, doctors from New York University Hospital for Joint Diseases develop a model for decision-making when examining children with back pain.
Models of this type are called algorithms. In this algorithm the physician begins by taking a history and conducting a physical exam. Blood tests and X-rays are ordered. Blood tests can show if there’s an infection or leukemia. X-rays may show a specific problem or deformity.
If the X-rays are negative, then the doctor takes a closer look at the patient’s symptoms. Constant, intense pain that wakes the patient up at night is a red flag. An MRI is advised. For patients with a negative X-ray and symptoms that come and go or get better or worse, conservative treatment is offered. Sometimes the X-ray is negative but the MRI is positive. In those cases, once the diagnosis is made, then treatment can begin for that problem.
Using an algorithm of this type can help doctors determine which signs, symptoms, or test results can predict a specific diagnosis. The authors used this algorithm on 87 pediatric patients with back pain.
More than one-third (36 percent) had a specific diagnosis either from the X-rays or the MRI. The presence of four symptoms was 100 percent accurate for having a specific problem. The four predictors were: 1) constant pain, 2) night pain, 3) radicular pain (back and leg pain), and 4) an abnormal neurological exam.
Using this algorithm can lead to a diagnosis for back pain in children without exposing them to excess radiation and cost. Having a specific diagnosis helps direct treatment sooner. The authors advise a wait-and-see approach when patients have full spinal motion and no radicular symptoms.