Clinical and Paraclinical Features and Final Diagnoses of Limping in Hospitalized Children at a Tertiary Referral Center in Rasht, Iran

Abstract

Background: Limping in children is a common clinical presentation that requires a meticulous diagnostic approach to distinguish benign, self-limited conditions from serious pathology. Objectives: This study aimed to evaluate the clinical and paraclinical profiles and etiologies of children hospitalized for limping in a tertiary care setting. Methods: We conducted a retrospective cross-sectional study of 166 children aged 1 - 18 years who were admitted to a tertiary referral hospital with a limp between January 2018 and December 2022. Data on demographics, clinical manifestations, laboratory investigations, and final discharge diagnoses were analyzed using descriptive statistics. Results: The cohort comprised 166 patients, of whom 61.4% were male. The mean age was 6.1 ± 3.1 years, with the highest prevalence observed in the 4 - 7-year age group (48.1%). An acute clinical presentation was observed in 57.2% of cases. The most frequent diagnoses were reactive arthritis (25.3%) and viral myositis (20.4%), followed by transient synovitis and septic arthritis (10.2% each). Joint pain was the primary symptom (61.4%), with single-joint involvement in 65.6% of patients, most commonly affecting the hip, knee, and ankle. Fever was documented in 49.4% of cases. Patients with septic arthritis had the highest rates of leukocytosis (52.9%) and elevated C-reactive protein (82.3%), as well as the highest mean erythrocyte sedimentation rate (55.4 mm/h). The longest hospitalization duration was observed in cases of Guillain-Barré syndrome (11.7 ± 5.1 days). Conclusions: Limping in children encompasses a broad diagnostic spectrum. Our findings highlight that structured clinical evaluation, supported by targeted laboratory investigations, is essential for timely diagnosis and appropriate management. These data may serve as a practical reference for clinicians managing acute limping in pediatric patients.