Changes

September 2025 —  reviewed. A literature search was conducted in August 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to recommendations have been made.

Update

Goals

To support primary healthcare professionals to:

• Assess a child presenting with an acute limp.
• Consider the differential diagnoses based on the age of the child.
• Arrange specialist assessment where appropriate.
• Manage the child in primary care where appropriate.

Outcome measures

Audit criteria

QOF indicators

QIPP - Options for local implementation

NICE quality standards

What is it?

• A limp is defined as an asymmetric gait and a deviation from a normal age-appropriate gait pattern  [Morancie, 2023].
  • A child develops a mature gait pattern at age 3 years, and it consists of a stance phase, during which the foot is in contact with the ground, and a swing phase, during which the foot is in the air [Payares-Lizano, 2020; AlRohaimi, 2024]. 
  • A limp is a clinical presentation and not a diagnosis, and is secondary to pain, weakness, or deformity as a result of a variety of conditions.
• Antalgic gait is the most common type of limp encountered in children, and pain is a presenting feature in 80% of cases [Morancie, 2023].
  • There is a shortening of the stance phase and an increase of the swing phase, with the child 'hurrying' off one leg to offload a source of pain [Adamson, 2020].
  • This type of gait results typically from trauma or an infection [Vezzetti, 2023].
• Non-antalgic gaits are less common and include [AlRohaimi, 2024]:
  • A Trendelenburg gait — where the pelvis exhibits a downward tilt towards the unaffected side during the swing phase because of weakness in the contralateral gluteus medius muscle. This type of gait is usually seen in disorders of the hip, such as developmental dysplasia of the hip, Perthes' disease, or slipped capital femoral epiphysis.
  • A steppage gait — results from excessive flexion of the hip and knee joints during the swing phase due to an inability to dorsiflex the foot. This type of gait is seen in children with cerebral palsy and other neurologic disorders.
  • A vaulting or circumduction gait — results from hyperextension and locking of the knees at the end of the stance phase, and the child must vault over the affected extremity. This type of gait is usually associated with a limb-length discrepancy or a mechanical disorder leading to abnormal knee mobility.

How common is it?

• Limping in children is a common problem [Adamson, 2020; Yagdiran, 2020].  One study reports that 2 in every 1000 accident and emergency visits for children less than 14 years of age are because of a limp [AlRohaimi, 2024]. A few studies have looked at incidence within specific populations:
  • One study in the US found that about 4% of paediatric patient encounters in the emergency department were due to limp [Singer, 1985].
  • A large national survey in the Netherlands of 73,954 children aged 0–14 years presenting to general practices identified 101 episodes of acute non-traumatic hip pathology causing pain and/or limp with a total incidence rate of 148.1 per 100,000 person-years [Krul, 2010].
  • Current data from a 2024 literature search show the incidence of atraumatic limping children presenting to an emergency department ranges from 1.8 to 2.8 children out of 1000, an average age of 4.4–5.2 years old and a slight male predominance (male-to-female ratio of 1.7:1) [Cristaldi, 2024].

What causes it?

• Acute limp in childhood can be caused by a wide range of conditions. The differential diagnoses can be categorized according to age group, although some serious conditions may occur at any age [Khan, 2020; Morancie, 2023; Vezzetti, 2023; Cristaldi, 2024]:
  • Younger than 3 years
    • Fracture or soft tissue injury (may be due to 'toddler's fracture' or child maltreatment).
    • Developmental dysplasia of the hip.
  • 3–10 years
    • Transient synovitis.
    • Fracture or soft tissue injury (may be due to stress fracture or child maltreatment).
    • Perthes' disease.
  • 10–18 years
    • Fracture or soft tissue injury (may be due to stress fracture or child maltreatment).
    • Slipped upper femoral epiphysis.
    • Perthes' disease.
    • Osgood-Schlatter disease.
    • Sever's disease.
    • Osteochondritis dissecans.
    • Chondromalacia patellae.
  • Any age 
    
    • Infection, such as septic arthritis, osteomyelitis, or discitis.
    • Malignancy, such as sarcoma, leukaemia, and lymphoma.
    • Non-malignant haematological disease, such as sickle cell disease and haemophilia.
    • Metabolic disease, such as rickets or vitamin C deficiency.
    • Neuromuscular disease, such as cerebral palsy or spina bifida (usually diagnosed before the child is walking), or muscular dystrophy.
    • Inflammatory muscle or joint disease, such as juvenile idiopathic arthritis.
    • Primary anatomical abnormality, such as limb length discrepancy.
    • Non-musculoskeletal causes, such as inguinal hernia, appendicitis, and testicular torsion.
• See the section on Differential diagnosis for more information on these conditions.

How should I assess a child with a limp?

It is important to consider the child's age as certain causes of limp are more common in specific age groups.

• Take a history from the child and/or their parents/carers. Ask about:
  • The duration and progression of limping.
    • Acute onset may suggest trauma, infection, or inflammation. 
  • A history (or a possibility) of trauma.
    
    • Always be aware of the possibility of child maltreatment. Check the child's medical records for previous injuries or child protection concerns. See the CKS topic on Child maltreatment - recognition and management for further information.
    • If the history of the presentation is not consistent with the degree of trauma, consider non-traumatic causes of joint pathology.
  • Any precipitating factors.
    • A history of a viral infection prior to the onset of limping is likely due to transient synovitis or reactive arthritis. 
  • Any associated pain. 
    • Ask about the nature, location, severity, and timing of pain.
    • Pain that is constant, localizing, and reproducible usually represents a fracture, osteomyelitis, or septic arthritis.
    • In infants, pain during nappy changes, causing back flexion, may indicate discitis.
    • Be aware that young children may not be able to verbalize or localize their pain.
  • Any associated muscle weakness.
    • This could indicate a possible neuromuscular disease.
  • Birth and developmental history.
    • This should include walking history, any neurodevelopmental delay or regression, and risk factors for developmental dysplasia of the hip, if appropriate. 
    • Delay in motor milestones suggests a neuromuscular cause, whereas regression suggests acquired disease (such as inflammatory arthritis).
  • Any family history of rheumatological or neuromuscular disease, such as juvenile idiopathic arthritis (JIA) or muscular dystrophy.
    • Family history is often negative with JIA.
• Perform a general examination.
  • Check for:
    • Pyrexia and tachycardia — may indicate sepsis.
    • Pallor, irritability, or lethargy — may indicate sepsis or systemic disease.
    • Unexplained rash or bruising — may indicate haematological or inflammatory joint disease, or raise the possibility of child maltreatment. See the CKS topic on Child maltreatment - recognition and management for further information.
    • Generalized lymphadenopathy or rash — may indicate infection, inflammatory joint, or haematological disease.
  • Note the height and weight of the child and, if possible, compare these with those from prior visits — poor growth may be an indicator of an underlying chronic disease. 
• Perform a musculoskeletal examination. The pGALS (paediatric Gait, Arms, Legs and Spine) assessment is a musculoskeletal screening examination for use in children. A demonstration of the components of the pGALS approach is available here.
  • • Check that the child can weight bear.
    • Check for scoliosis, tufts of hair on the spine or a sacral pit — may indicate spina bifida.
    • Check for leg length discrepancy or pelvis asymmetry.
    • Compare both lower limbs looking for joint asymmetry, erythema, swelling, bruising, lacerations, or deformity.
    • Check for calf muscle hypertrophy — may indicate muscular dystrophy.
    • Check for signs of evolving compartment syndrome, including agitation, pain disproportionate to the injury, and palpable swelling.
  • Feel
    • Check for focal bony and muscle tenderness, swelling, or heat over the spine, pelvis, lower limbs, abdomen, and testicles (if appropriate).
    • Check for pulses and carry out a peripheral neurological examination of the lower limbs to assess for neurovascular compromise.
  • Move
    • Depending on the child's age, examine the gait (including walking on heels and tiptoes and running) looking for a gait abnormality, such as an antalgic or Trendelenburg gait.
    • Assess the range of movement in each joint, especially the hip. Children presenting with knee pain may have referred pain from the hip. Examine the joints adjacent to the affected joint to rule out referred pain.
• Red flags that may indicate an underlying serious disease or condition in a child presenting with an acute limp include:
  • Pain waking the child at night — may indicate malignancy.
  • Redness, swelling, or stiffness of the joint or limb — may indicate infection or inflammatory joint disease.
  • Weight loss, anorexia, fever, night sweats, or fatigue — may indicate malignancy, infection, or inflammation.
  • Unexplained rash or bruising — may indicate haematological or inflammatory joint disease, or child maltreatment.
  • Limp and stiffness worse in the morning — may indicate inflammatory joint disease.
  • Unable to bear weight or painful limitation of range of motion — may indicate trauma or infection.
  • Severe pain, anxiety, and agitation after a traumatic injury —  may indicate neurovascular compromise or impending compartment syndrome.
  • A palpable mass — may indicate malignancy or infection.

What are the differential diagnoses for acute limp in children?

The differential diagnoses for acute limp can be categorized according to age group, although some serious conditions may occur at any age. 

Younger than 3 years

• Fracture or soft tissue injury (may be due to 'toddler's fracture' or child maltreatment).
  • A fracture will present with point tenderness over the bone, redness, or bruising and swelling in the affected area. 
  • A 'toddler fracture' is a subtle, undisplaced spiral fracture of the tibia typically seen in pre-school children. It is usually caused by a sudden twist, often after an unwitnessed fall. Affected toddlers (often new walkers) present with difficulty or refusal to bear weight.
  • A sprain is a stretch and/or tear of a ligament. A strain (or 'pull') is a stretch and/or tear of muscle fibres and/or tendons. Children have growth plates that are more susceptible to injury than ligaments. An apparent sprain in a child should raise suspicion of an injury to the growth plate. See the CKS topic on Sprains and strains for more information.
  • Always be aware of the possibility of child maltreatment. The presence of unusual skin marks, multiple bruises of varying ages, recurrent instances of 'unexplained' injury, delayed presentation, and certain types of injuries (such as fractures) should raise suspicion of child maltreatment. See the CKS topic on Child maltreatment - recognition and management for more information.
• Developmental dysplasia of the hip (DDH).
  • DDH is a congenital condition where the ball and socket hip joint fails to develop normally.
  • Risk factors include being a firstborn child, female sex, family history of DDH, breech presentation at birth, and oligohydramnios. A physical exam may reveal asymmetric skin folds, extremity shortening, and limited hip abduction. 
  • Undiagnosed and then untreated, DDH may lead to hip pain and/or osteoarthritis in older children.

3–10 years

• Transient synovitis.
  • A self-limiting inflammatory disorder of the hip.
  • It is more common in boys than in girls. It affects young school-aged children but is rare in children aged younger than 3 years.
  • Childhood risk of at least one episode is 3%.
  • It presents acutely with mild to moderate hip pain and limp, and there is no (or mild) restriction of hip movements, especially abduction and internal rotation. Children are otherwise well and afebrile. There is usually a history of viral illness, but the absence of a viral illness does not rule out the possibility of synovitis.
  • The diagnosis of transient synovitis is one of exclusion, after other causes of hip pain and limp have been ruled out.
• Fracture or soft tissue injury (may be due to stress fracture or child maltreatment).
• Perthes' disease (also called Legg-Calve-Perthes' disease).
  • An idiopathic avascular necrosis of the developing femoral head.
  • It is 5 times more common in boys than in girls. Peak incidence is between ag 5-7 years.
  • The incidence is 1-11 per 100,000 children per year.
  • Onset is usually over weeks, and the child will typically present with limitation of hip rotation and a subacute limp sometimes with referred pain to the groin, thigh, or knee. It is typically unilateral, though bilateral involvement is present in 10-20% of cases. The child is systemically well with no other joint involvement and no evidence of joint inflammation. 
  • Most children with Perthes' disease have good outcomes, but long-term complications may include chronic pain and osteoarthritis.

10–19 years

• Fracture or soft tissue injury (may be due to stress fracture or child maltreatment).
• Slipped upper femoral epiphysis.
  • A displacement of the proximal femoral epiphysis from the metaphysis. 
  • It is slightly more common in boys than girls and in adolescents who are overweight.
  • The incidence is 4.8 cases per 100,000 children per year.
  • It can present with an acute/insidious onset of pain (hip, thigh, or knee), and the child may walk with an antalgic gait out-toeing, with shortening of the affected limb. It is sometimes associated with endocrine abnormalities, such as hypothyroidism, and in children being treated for growth hormone deficiency or with a history of radiotherapy treatment.
  • Prompt diagnosis is crucial to avoiding further displacement and the development of avascular necrosis.
• Perthes' disease.
• Osgood-Schlatter disease.
  • An overuse injury caused by multiple small avulsion fractures within the ossification centre (apophysis) of the tibial tuberosity at the inferior attachment of the patellar ligament.
  • It is a usually self-limiting disorder causing anterior knee pain during adolescence. 
  • See the CKS topic on Osgood-Schlatter disease for more information.
• Sever's disease.
  • An overuse injury thought to be caused by repetitive microtrauma from the pull of the Achilles tendon on the unossified apophysis.
  • It is most common in boys aged 10–12 years who are active in sports, such as running and football, and produces heel pain as a result of inflammation of the calcaneal apophysis. 
  • It often resolves within 2 weeks to 2 months, but a child may have recurrent symptoms until skeletal maturity.
• Osteochondritis dissecans.
  • Occurs when a small piece of subchondral bone begins to separate from its surrounding area due to a disturbance of the local blood supply. This bone and the cartilage covering it may break loose, causing pain and possibly hindering joint motion.
  • It is the most common cause of a loose body in the joint space, typically affecting the knee between the ages of 10–19 years.
  • The aetiology is uncertain but trauma, vascular abnormalities, defects in ossification, and genetics have all been suggested as possible causes. Clinical findings are subtle and a small effusion or limited range of joint movement may be the only sign. Locking or instability suggest a loose body in the joint.
• Chondromalacia patellae.
  • Describes anterior knee pain typically felt when walking up or down stairs.
  • Affects children between the ages of 10–19 years in a ratio of three girls to two boys.

Any age 

• Septic arthritis and osteomyelitis.
  • Septic arthritis is an infection of the synovium and joint space. It can present in any joint but most commonly affects the lower limbs, and can lead to joint destruction, permanent loss of joint function, and sepsis. Clinical features include refusal to bear weight and fever. There may be evidence of joint inflammation. 
  • Osteomyelitis is an infection of the bone. It usually involves a single bone but may rarely affect multiple sites, and can lead to inflammation and bone destruction. The most common presenting signs are pain with palpation and decreased limb use. Osteomyelitis of the proximal femur can be difficult to distinguish from septic arthritis on physical examination. 
  • The clinical presentation of osteomyelitis and septic arthritis may mimic that of transient synovitis. However, transient synovitis is rare in children younger than 3 years of age. 
  • The incidence of osteomyelitis is 9 cases per 100,000 and septic arthritis is 4-5 cases per 100,000 children per year.
  • Four independent predictors have been proposed and validated to aid in the differentiation of transient synovitis and septic arthritis: history of fever, non-weight-bearing on the affected side, erythrocyte sedimentation rate (ESR) greater than 40 mm/h, and serum white blood cell count of more than 12,000 cells/mm³.
• Other infections (for example discitis).
  • Discitis is an inflammation of the disc space and adjacent vertebral endplates that typically affects the lumbar spine.
  • It is more common in neonates and young children.
  • Presentation can be very non-specific, and a high index of suspicion is required for diagnosis. Clinical presentation ranges from refusal to walk or bear weight to irritability on spine immobility. Point tenderness over the spine can aid in the diagnosis. It may also present with unusual symptoms, such as abdominal pain, limp, hip or leg pain.
  • Limited spinal flexion, stiff posture, and local tenderness on spine examination are also suggestive of discitis.
• Malignancy.
  • Primary bone tumours, soft tissue sarcoma, leukaemia, and lymphoma can present with a limp due to lesions in the pelvis or lower limbs. See the CKS topics on Bone and soft tissue sarcoma - recognition and referral and Haematological cancers - recognition and referral for further information.
  • The most common bone tumour in children is osteosarcoma, which peaks in incidence after 10 years of age. The incidence is 4-7 per million children per year. Leukaemia and neuroblastoma are the most common non-bone tumours in children. 
  • Clinical findings that may indicate malignancy include night pain, hepatosplenomegaly, lymphadenopathy, or pathological fractures.
• Non-malignant haematological disease (such as sickle cell disease and haemophilia).
  • Sickle cell disease encompasses a group of inherited conditions that have the inheritance of sickle haemoglobin in common. It can cause a limp through avascular necrosis of the hip, increased susceptibility to infections (including osteomyelitis), and stroke (about 10% of children with sickle cell disease are at risk of stroke, which may present as sudden onset of a limp). See the CKS topic on Sickle cell disease for more information.
  • Haemophilia may result in easy bruising, bleeding after dental procedures, haemarthrosis, soft-tissue/muscle haematomas in toddlers, and swollen joints in active toddlers (usually boys). May be related to family history of bleeding disorders.
• Metabolic disease (such as rickets or vitamin C deficiency).
  • Osteomalacia is due to a lack of vitamin D or problems with its metabolism.
  • When osteomalacia affects the growing skeleton, it is referred to as rickets. Clinical features of rickets include bone pain and tenderness, skeletal deformity (such as bowing of the legs) and kyphoscoliosis, and proximal muscle weakness.
  • Early signs of vitamin C deficiency are unspecific, but later musculoskeletal signs and symptoms are common and include myalgia, haemarthroses and haematomas. It is a rare presentation but should not be overlooked.
• Inflammatory muscle or joint disease (such as juvenile idiopathic arthritis [JIA] and Lyme arthritis).
  • JIA encompasses a group of disorders presenting with inflammatory joint disease in children. It is characterized by joint pain, swelling without a large effusion, and morning stiffness that persists for longer than 6 weeks, and has no known cause. It can affect single or multiple joints. Systemic symptoms of lethargy and anorexia may be present. Eye involvement in the form of uveitis is also commonly noted. Often children with JIA are otherwise well and blood tests and X-rays may be normal.
  • Lyme arthritis is the second most common symptom to the classic rash associated with Lyme disease. In cases where the erythema migrans rash (commonly called the bull’s eye rash) does not appear or goes unnoticed, Lyme arthritis may be the first clinical sign. It typically presents without a fever. The child will bear partial weight and present with a limp. 
• Other conditions, including:
  • Neuromuscular disease, such as cerebral palsy or spina bifida (usually diagnosed before the child is walking).
  • Muscular dystrophies, such as Duchenne's and Becker's disease.
  • Primary anatomical abnormality, such as limb length discrepancy.
  • Non-musculoskeletal conditions, including intra-abdominal pathology (such as inguinal hernia and appendicitis) and inguinoscrotal disorders (such as testicular torsion).

Scenario: How should I manage a child presenting with acute limp?

From birth to 18 years.

Search strategy

Scope of search

A literature search was conducted for guidelines and systematic reviews and randomized controlled trials on primary care management of acute childhood limp.

Search dates

August 2020 - August 2025

Key search terms

The terms listed below are the core search terms that were used for EBSCOhost MEDLINE (searched 6th August 2020). These were combined with filters to identify guidelines, systematic reviews and primary care relevant literature in EBSCOhost MEDLINE. The strategy was adapted for The Cochrane Library databases.  

S9 S5 AND S8
S8 S6 OR S7 
S7 AB ( child* or schoolchild* or infant* or infancy OR adolescen* or pediatr* or paediatr* or neonat* or boy or boys or girl or girls or youth or youths or baby or babies or toddler* or teen or teens or teenager* or newborn* or puberty or young people ) OR TI ( child* or schoolchild* or infant* or infancy OR adolescen* or pediatr* or paediatr* or neonat* or boy or boys or girl or girls or youth or youths or baby or babies or toddler* or teen or teens or teenager* or newborn* or puberty or young people)
S6 (MH "Child+") OR (MH "Infant+") OR (MH "Adolescent")
S5 S1 OR S2 OR S3 OR S4 
S4 AB (walk* N2 abnormal*) OR TI (walk* N2 abnormal*) 
S3 AB ( (gait N2 (abnormal* or disturb* or antalgic or disorder*)) ) OR TI ( (gait N2 (abnormal* or disturb* or antalgic or disorder*)) ) 
S2 AB ( limp or limping ) OR TI ( limp or limping ) 
S1 (MH "Gait+") 

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• World Health Organization
• Guidelines International Network
• TRIP database
• Agency for Healthcare Research and Quality
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work (occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Drug and Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium (HMIC)

Patient experiences

• Healthtalk
• BMJ - Patient Journeys

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
• Consistency with other providers of clinical knowledge for primary care.
• Accuracy of implementation of national guidance (in particular NICE guidelines).
• Usability.

Principles of the consultation process

• The process is inclusive and any individual may participate.
• To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
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• Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
• External reviewers are not paid for commenting on the draft topics.
• Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
• All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
• All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

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Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
• Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
• Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
  • Eligible population
  • Current interventions
  • Likely uptake of new intervention or recommendation
  • Cost of the current or new intervention mix
  • Impact on other costs
  • Condition-related costs
  • In-direct costs and service impacts
  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

• Personal financial interests
• Personal family interest
• Personal non-financial interest
• Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

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Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.