Thus, the survey was emailed to a total of 451 MN pediatricians (Figure 1). pain and other non-specific symptoms such as fatigue are quite common among children, with rates up to 40% for MSK pain and 30% for fatigue.2,3 Therefore the PPV of rheumatology laboratory checks among this group of pediatric individuals is likely to be low. Particular caution should be taken with particular rheumatology checks such as the antinuclear antibody (ANA) and the human being leukocyte antigen (HLA)-B27 genetic test which have been found to be positive in a relatively large percentage of healthy children.4C6 Moreover, the diagnostic criteria of most pediatric rheumatic diseases, including juvenile idiopathic arthritis (JIA), are based upon clinical findings rather than laboratory test results. Such checks may be helpful in categorizing the disease or prognosticating its program, but they are not used to establish the diagnosis. For example, even though rheumatoid element (RF) and Acenocoumarol anti-cyclic-citrullinated peptide (CCP) antibody checks are used to display for adult rheumatoid arthritis, these checks are only positive in approximately 3% of children with JIA because only a small subset of JIA individuals have a disease equivalent to adult rheumatoid arthritis. 7C9 It is for these reasons that current recommendations do not support the use of ANA, anti-double-stranded DNA (dsDNA) antibody, RF, anti-CCP antibody, or HLA-B27 as diagnostic checks for undiagnosed MSK pain.6,10C15 Furthermore, MSK pain without other signs such as joint swelling or gait abnormality is rarely caused by an inflammatory condition.16 Nonetheless, many referrals come to the pediatric rheumatology (PR) clinic for positive rheumatology laboratory tests of uncertain significance and non-specific complaints such as MSK pain without evidence of arthritis or other physical examination abnormalities. The primary goal of this study was to survey primary pediatricians to determine the frequency of use of common rheumatology checks and to understand the reasons behind purchasing them. The secondary goals were to quantify the rate of recurrence of referral to the PR medical center for positive test results of uncertain significance and to investigate factors associated with appropriate utilization of these checks. Methods Physician study human population All general pediatricians training in Minnesota (MN), North Dakota (ND) and South Dakota (SD) having a valid email address were eligible for the survey. The MN and ND pediatricians email addresses were from the MN Table of Medical Practice and the ND Table of Medical Examiners. The SD pediatricians email addresses were from the SD chapter of the American Academy of Pediatrics. The MN Table of Medical Practice Acenocoumarol database contained contact info for 1322 pediatricians. Of these, 690 were eliminated due to duplicate entries, missing email address, or because the physician was not a general pediatrician. This remaining 632 MN pediatrician email addresses. When a notification about the survey was sent one week prior to the survey, 26 email addresses were found to be FGF9 invalid and 30 physicians asked to be removed from the survey list. An additional 125 pediatricians were eliminated because they were determined to be pediatric subspecialists based upon a systematic review of each remaining physician in the database using Healthgrades.com. Therefore, the survey was emailed to a total of 451 MN pediatricians (Number 1). The survey was also emailed to a total of 76 pediatricians training in SD and 82 training in ND, however, the investigators did not have direct access to these databases; rather the link to the survey was forwarded to the pediatricians from the administrators of the databases. This survey was determined to be exempt from formal institutional evaluate board (IRB) evaluate at Acenocoumarol the University or college of Minnesota. Open in a separate window Number 1 Main pediatrician study human population Instrument The survey queried pediatricians to assess their encounter in pediatric rheumatology, reasons for referring individuals to PR and assessment of utilization of rheumatology laboratory checks. In order to.