VARIABILITY IN PHYSICIANS REPORTED ORDERING AND PERCEIVED REASSURANCEVALUE OF DIAGNOSTIC-TESTS IN CHILDREN WITH GROWING PAINS

Objectives: To determine the variability in the reported ordering of t ests and treatment and to determine physicians' perceptions of the rea ssurance value to families of diagnostic tests in children with ''grow ing pains.'' Design: Cross-sectional survey using a mailed questionnai re. Settings: Primary care and referral practices in Toronto, Ontario. Participants: University-affiliated primary care pediatricians and fa mily physicians were surveyed, as well as all pediatric orthopedic sur geons and pediatric rheumatologists in Ontario. Pediatric orthopedic s urgeons and pediatric rheumatologists were combined into a single grou p. Main Outcome Measures: Frequency of office visits because of growin g pains, frequency of diagnostic testing, management strategies for th ese children, and physicians' perceptions of the reassurance value of diagnostic tests. Results: Of 205 eligible physicians, 181 (88.3%) res ponded. The median reported frequency of office visits because of grow ing pains was 1%. Compared with the other physician groups, family phy sicians were significantly more likely to order a determination of the hemoglobin level (P=.003), erythrocyte sedimentation rate (P=.01), wh ite blood cell count (P=.01), and differential blood cell count (P=.00 3), but not imaging tests. Family physicians were also more likely to order diagnostic tests when they were under parental pressure to do so (P=.001) or for the child with repeated visits (P=.02). In total, 86% of pediatric orthopedic surgeons and pediatric rheumatologists, 95% o f pediatricians, and 100% of family physicians perceived normal test r esults to be reassuring to parents. Treatment strategies were similar across the 3 physician groups. Conclusions: The frequency of diagnosti c testing varied among physician groups. Virtually all physicians perc eived normal test results to be reassuring to families.