2005-21年儿童和年轻人新发肌肉骨骼疼痛后的预后：基于人群的研究
Prognosis after a new episode of musculoskeletal pain in children and young people, 2005-21: population-based study
基于CPRD Aurum 2005-2021年数据，313,830名8-18岁新发肌肉骨骼疼痛的儿童和年轻人中，32%在12个月内因肌肉骨骼疼痛再次就诊。240,384名随访超3年者呈现三种轨迹：单次发作（62%）、早期再就诊（18%）和持续再就诊（20%）。年龄较大、女性、髋/膝/多部位/背痛、既往头痛或腹痛及镇痛药处方与再就诊风险升高相关；亚裔或黑人及更贫困地区居民记录到的再就诊率较低。
Abstract
Objective: to estimate reconsultation risk and trajectories after a new episode of musculoskeletal pain in children and young people (CYP), and to determine routinely recorded prognostic factors associated with reconsultation. Design: Population based retrospective cohort study. Setting: Clinical Practice Research Datalink (CPRD) Aurum, 2005-2021. Participants: CYP aged 8–18 years consulting primary care for a new musculoskeletal pain episode (no musculoskeletal consultation in prior 12-months). Main Outcome Measures: Musculoskeletal pain reconsultation within 12-months, and 3-year musculoskeletal reconsultation trajectories derived using latent class growth analysis. Prognostic factors selected from a literature search and two-year symptom histories (sample prevalence >1%) were examined using regression models (conditional logistic; multinomial). Results: Among 313,830 CYP with >12 months′ follow-up, 32% reconsulted for musculoskeletal pain within 12 months. Among 240,384 CYP with >3 years′ follow-up, three trajectories were observed: single episode (62%), early reconsultation (18%), and persistent reconsultation (20%). Older age; female gender; hip, knee, multisite and back pain on index; previous headache; previous abdominal pain; and analgesic prescribing were associated with higher reconsultation risk. Asian or Black ethnicity, and residing in more deprived areas, were associated with lower recorded reconsultation. Conclusion: Most CYP had no further recorded consultation, but 38% followed early or persistent reconsultation trajectories. Routinely recorded prognostic factors, particularly index pain side and prior pain/symptom history, may differentiate groups who could benefit from proactive follow-up. Lower recorded reconsultation among Asian and Black individuals, and living in more deprived areas, should not imply lower need and warrants equity-sensitive monitoring of access, health-seeking, and coding.
Competing Interest Statement
The authors have declared no competing interest.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The Clinical Practice Research Datalink (CPRD) CPRD has Health Research Authority approval to support research using anonymised patient data. This study was approved by the CPRD Research Data Governance Process (ref 23_002782; protocol made available to this manuscript′s reviewers). Under CPRD′s ethical approval from the UK Health Research Authority to support research using anonymised patient data, individual patient consent is not required as patients contributing data to CPRD cannot be identified from the data made available to researchers. Data from CPRD adheres to the ethical principles outlined in the Declaration of Helsinki.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Data Availability
Data may be obtained from a third party and are not publicly available. The data were obtained from the Clinical Practice Research Datalink. Clinical Practice Research Datalink data governance does not allow us to distribute patient data to other parties. Researchers may apply for data access at http://www.CPRD.com/. Code lists are openly available at https://doi.org/10.21252/eye3-tq63.
https://doi.org/10.21252/eye3-tq63
Funder Information Declared
National Institute for Health Research, https://ror.org/0187kwz08, NIHR203281, NIHR200165, NIHR300957, NIHR508051
来源：medRxiv · 临床预印本 · medrxiv.org