Patients’ delay is the major cause for late diagnosis of slipped capital femoral epiphysis

Abstract

Early diagnosis of slipped capital femoral epiphysis (SCFE) is essential in order to reduce slip severity and subsequent risk of sequelae. The aims of this study were to evaluate patients’ and doctors’ delay in SCFE diagnosis and to identify possible factors leading to delay. We performed a retrospective review of medical charts and a personal interview with 54 consecutive patients admitted with a diagnosis of stable SCFE at three hospitals in Sweden between 2001 and 2009. Data on symptom duration, symptomatology, medical visits and type of medical contacts were retrieved. Slip angle (Southwick head-shaft angle) was measured. Median total delay from onset of symptoms to surgery was 26 weeks (range 1-109). Patients’ delay was significantly longer than doctors’ delay: 10 weeks (range 1-57) vs. 4 weeks (range 0-57) (P=0.002). Boys had significantly longer patients’ delay than girls (13 vs. 6 weeks, P=0.021) but not doctors’ delay. Children with dominance of knee pain had significantly longer doctors’ delay (14 vs. 4 weeks, P=0.002) but not patients’ delay. As expected, the total delay duration correlated with slip severity (R=0.59, P<0.001). Results demonstrate considerable delay in diagnosis of SCFE in Sweden, although the major cause is patients’ delay. Boys and children with dominance of knee pain are more likely to be diagnosed late. Efforts to increase the awareness of SCFE directed to both the general society and healthcare providers are necessary to improve future outcomes. Level III. Retrospective comparative study.

Do Patient Demographics and Socioeconomic Status Influence Severity and Time to Diagnosis in Children With Stable Slipped Capital Femoral Epiphysis?

“…In patients with slipped capital femoral epiphysis (SCFE), the symptoms are often enigmatic 1,2. The average duration of symptoms in children with stable SCFE is several months 3–5. SCFE severity is loosely correlated with symptom duration 2,3,6,7.…”

“…1,2 The average duration of symptoms in children with stable SCFE is several months. [3][4][5] SCFE severity is loosely correlated with symptom duration. 2,3,6,7 The diagnosis is often missed early [8][9][10] because of symptoms of knee pain, 2,5 nebulous history, 1 and Medicaid insurance.…”

“…[3][4][5] SCFE severity is loosely correlated with symptom duration. 2,3,6,7 The diagnosis is often missed early [8][9][10] because of symptoms of knee pain, 2,5 nebulous history, 1 and Medicaid insurance. 2 Postulated programs to reduce the delay in diagnosis of SCFE should emphasize patients with knee/thigh pain and those with Medicaid coverage.…”

Examining delays in diagnosis for slipped capital femoral epiphysis from a health disparities perspective

“…Slipped Capital Femoral Epiphysis (SCFE) is a musculoskeletal condition seen in the pediatric population where the physis (or "growth plate") of the proximal femur between the head and neck becomes unstable, and the femoral head slips posteriorly and inferiorly away from the neck of the femur. Because SCFE progresses until the physis fuses, early diagnosis and treatment is key [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Unfortunately, delayed diagnosis with SCFE patients can occur, often in patients with uncharacteristic pain presentation and public insurance.…”

“…The degree of slip severity has been significantly correlated with delays in diagnosis in several studies [1,2,5,7,9,13,44]. A higher slip severity increases the likelihood of premature osteoarthritis and additional surgeries (e.g., osteotomies, and in some cases total hip replacements), whereas a patient diagnosed with a mild slip typically has a better outcome [2,[45][46][47][48].…”