The Delay in Diagnosis of Slipped Capital Femoral Epiphysis: A Review of 102 Patients

HSS Journal


Daniel W. Green, MD, MS, FAAP, FACS

Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

Richard A.K. Reynolds, MD
Children's Hospital of Los Angeles, Los Angeles, CA
Safdar N. Khan, MD
Hospital for Special Surgery
Vernon Tolo, MD
Children's Hospital of Los Angeles, Los Angeles, CA

Abstract
Objectives: The aim of this study were (1) to evaluate the incidence of apparent missed diagnosis of slipped capital femoral epiphysis (SCFE) by the primary care system and (2) to identify possible factors leading to a delay in diagnosis of this disorder.

Setting and Design: A retrospective review of emergency room records, outside medical charts and preoperative and postoperative radiographs of children treated surgically for SCFE at The Children's Hospital of Los Angeles (CHLA) from 1989 to 1997 was done to assess the delay in diagnosis for SCFE. The primary care system included outside emergency room visits, urgent care clinics and private office visits.

Results: Of 102 patients (69 male; 33 female; mean age at surgery, 11.9 years). 68% of patients were above the 95th percentile mean weight for age. Pain in the hip and/or groin was documented in 60%.The mean duration of symptoms experienced before being seen at CHLA was 140 days (hours to 1.5 years) and the mean delay after the first primary care visit till being seen at CHLA was 76 days (hours to 1 year). Fifty-two percent of primary care visits for hip, groin, knee or thigh pain in obese children did not lead to either a diagnosis of SCFE or a referral for orthopedic evaluation.

Conclusions: This study documents a 2 ½ month delay and a 52% incidence of apparent missed diagnosis for slipped capital femoral epiphysis by the primary care system. There appears to be a need for increased orthopedic education for primary care providers.

This article appears in HSS Journal: Volume 1, Number 1.
View the full article at springerlink.com.


About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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