Patterns of Pain in Adolescents with Slipped Capital Femoral Epiphysis

Uvodich, Mason E.; Schwend, Richard M.; Stevanovic, Ognjen; Wurster, Will; Leamon, Julia; Hermanson, Alec R.

doi:10.1016/j.jpeds.2018.10.050

Cited by 15 publications

(19 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 This has not been studied in the United States. The purpose of our study was to see (1) does socioeconomic status and patient demographics influence the time to diagnosis and severity of the SCFE; and (2) does Medicaid insurance decrease access to care for SCFE in Indiana.…”

mentioning

confidence: 99%

“…I n 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][4][5] SCFE severity is loosely correlated with symptom duration.…”

mentioning

confidence: 99%

“…[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.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Loder

Sun

Gunderson

2022

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background: The time to diagnosis in stable slipped capital femoral epiphysis (SCFE) is often several months because of nebulous history, symptoms of knee/thigh pain, and Medicaid insurance. This study examined the impact of socioeconomic status and demographics on the time to diagnosis and SCFE severity in Indiana children. Methods: A retrospective review of all patients at a tertiary children’s hospital with SCFE from January 2010 through March 2021 was performed. Standard demographic data and type of insurance was collected. Neighborhood Atlas Mapping was used to determine the state decile of the area deprivation index (ADI), a measure of socioeconomic status using 17 variables related to income, employment, education, and housing. Statistical analyses consisted of standard univariate and bivariate analyses; logistic regression analysis was used to determine predictors of a mild SCFE. A P<0.05 was considered statistically significant. Results: There were 142 patients; 81 male and 61 female. The average age was 12.2±1.7 years, lateral epiphyseal shaft angle of 35±19 degrees, and symptom duration of 4.5±5.0 months. There was no correlation between ADI state deciles and lateral epiphyseal shaft angle (r 2=0.008) or symptom duration (r 2=0.019). Insurance status and race differed by ADI deciles. In the first decile (least disadvantaged), 44% had government insurance and 89% were White; in the 10th decile (most disadvantaged), 95% had government insurance and 38% were White. Predictors of a mild SCFE were female sex [odds ratio (OR): 3.2 [1.5, 7.0]; P=0.004], symptom duration <3 months [OR: 5.3 (2.4, 11.7); P=0.00004], and White race [OR: 2.4 (1.3, 6.2); P=0.01]. Insurance status and ADI were not significant. Conclusions: Contrary to other studies, neither insurance or socioeconomic status were associated with a delay in diagnosis or SCFE severity. The symptom duration in children with SCFE does not appear to be decreasing over the last several decades. Further investigation is required as to why. Level of Evidence: Level III—retrospective comparative study.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Loder

Sun

Gunderson

2022

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Furthermore, another matter of debate is compliance, that is deeply required from parents in order not to miss any early diagnosis of SCFE to their children. The problem is that mild cases of SCFE can remain relatively pain-free, and consequently, parents may be tempted to abandon the prophylactic follow-up, leaving an unrecognized disease untreated ( 62 ). Finally, the radiographic follow-up unluckily does not prevent the occurrence of severe slips, which have the worst functional prognosis ( 63 ).…”

Section: Discussionmentioning

confidence: 99%

Role of the prophylactic fixation of contralateral unaffected hip in paediatric unilateral slipped capital femoral epiphysis: a systematic review

et al. 2022

View full text Add to dashboard Cite

The aim of this systematic review is to assess the role of the prophylactic fixation of contralateral unaffected hip in unilateral slipped capital femoral epiphysis (SCFE) in children, focusing on the possible complications of this surgical procedure. A systematic review of medical literature was conducted, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement, to analyse the complications of prophylactic contralateral hip fixation in unilateral paediatric SCFE. We registered the complications reported in the included studies, scoring their severity according to the orthopaedic adaptation of Clavien–Dindo classification. From 1695 studies primarily identified, 14 studies were finally included: 1 prospective cohort study, 4 retrospective case-control studies and 9 retrospective case series, with a total of 811 children diagnosed with unilateral SCFE and treated on the unaffected contralateral hip. Grade IV complications were very rare (0.37%), while the rate of grade III events was 8%. No death was recorded. The most frequent complication was unplanned further surgery (6.29%) that was an epiphyseal refixation, owing to the physiologic growth of the proximal femur, in 42 cases. Cannulated screws fixation showed to have a lower major complication rate than pinning with K-wires, 5.37% vs 17.95%. The prophylactic fixation of contralateral unaffected hip in paediatric unilateral SCFE is a safe procedure. Although a benefit-cost analysis on this topic has not been published yet, considering the low rate of complications, prophylactic hip fixation is a viable option for patients presenting with unilateral SCFE, to prevent the occurrence of severe hip deformity and avoid future invasive surgeries.

show abstract

“…In only half of the cases, the patients locate the pain at the hip joint [16]. Pain may reflect on the ipsilateral thigh and knee, or the patient may just complain of a painless limp [16,[24][25][26]. Radiographs may not be requested, or only the AP pelvis projection will be ordered, in an attempt to spare unnecessary radiation exposure of the child.…”

Section: Discussionmentioning

confidence: 99%

Causes of Delayed Diagnosis of Slipped Capital Femoral Epiphysis: The Importance of the Frog Lateral Pelvis Projection

Samelis

Loukas

Kantanoleon³

et al. 2020

Cureus

View full text Add to dashboard Cite

Patterns of Pain in Adolescents with Slipped Capital Femoral Epiphysis

Cited by 15 publications

References 26 publications

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

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

Role of the prophylactic fixation of contralateral unaffected hip in paediatric unilateral slipped capital femoral epiphysis: a systematic review

Causes of Delayed Diagnosis of Slipped Capital Femoral Epiphysis: The Importance of the Frog Lateral Pelvis Projection

Contact Info

Product

Resources

About