Socioeconomic Deprivation and its Associations With Follow-up Compliance After In Situ Pinning of Slipped Capital Femoral Epiphysis

Abstract

Background: Slipped capital femoral epiphysis (SCFE) is a common cause of hip pain in adolescents and is most often treated by in situ screw fixation. Orthopaedic follow-up is critical after treatment for SCFE due to risks of complications and subsequent contralateral slip. Recent studies have shown that socioeconomic deprivation is associated with decreased fracture care compliance, but no studies have explored this relationship with SCFEs. The study aims to determine the relationship between socioeconomic deprivation and SCFE follow-up care compliance. Methods: This study included pediatric patients treated with in situ pinning of SCFE between 2011 and 2019 at a single tertiary-care urban children's hospital. Demographic and clinical information were obtained from electronic medical records. The Area Deprivation Index (ADI) was used to quantify the socioeconomic deprivation of each. Outcome variables included patient age and status of physeal closure at the most recent appointment, in addition to the length of follow-up (mo). Statistical relationships were evaluated using nonparametric bivariate analysis and correlation. Results: We identified 247 evaluable patients; 57.1% were male, and the median age was 12.4 years. Most slips were stable (95.1%) and treated with isolated unilateral pinning (55.9%). Median length of follow-up was 11.9 months (interquartile range, 4.95 to 23.1) with median patient age at final visit of 13.6 years (interquartile range, 12.4 to 15.1). Only 37.2% of patients were followed until physeal closure. The mean ADI spread in this sample was similar to the national distribution. However, patients in the most deprived quartile were lost to follow-up significantly earlier (median, 6.5 mo) than those in the least deprived quartile (median, 12.5 mo; P < 0.001). Throughout the entire cohort, there was a significant, inverse relationship between deprivation and follow-up length (r s(238) = −0.3; P < 0.001), with this relationship most pronounced in the most deprived quartile. Conclusions: In this sample, ADI spread was representative of national trends, and the incidence of SCFE was distributed evenly across deprivation quartiles. However, follow-up length does not mirror this relationship; increased socioeconomic deprivation is associated with an earlier loss to follow-up (often well before physeal closure).

Missed Short-term Follow-up After Arthroscopic Rotator Cuff Surgery: Analysis of Surgical and Demographic Factors

“… 26 Similar results were demonstrated by the same group among patients who underwent surgical fixation of slipped capital femoral epiphysis. 27 The differences from our study include the fact that we studied elective surgery as opposed to trauma, our inclusion of only surgical patients, the adult nature of our patients, and our assessment using both state and national ADI data. Furthermore, given that ADI was not associated with 12-month follow-up suggests that at longer follow-up, socioeconomic factors may play less of a role in outpatient follow-up.…”

Decade-long Trends in Incidence of Slipped Capital Femoral Epiphysis in the United States: A Nationwide Database Analysis of Over 33 Million Patients

“…Furthermore, patients of lower SES may fare worse, with reports of early loss to follow-up, delayed diagnosis, and greater slip severity in this demographic. 14,15 Aside from this association, the increasing incidence of SCFE is cause for concern independently. SCFE is a frequently missed diagnosis, due to its various presentations and similarity to more common and relatively benign conditions leading to delays in treatment.…”

“…Furthermore, patients of lower SES may fare worse, with reports of early loss to follow-up, delayed diagnosis, and greater slip severity in this demographic. 14 , 15 …”

Prescription for Cash? Cash Support to Low‐Income Families in Maternal and Pediatric Health Care Settings

“…[30][31][32] Indeed, evidence suggests that low-income families have lower rates of visitation in the NICU and lower rates of follow-up care for a range of complex pediatric health conditions. [33][34][35][36] Addressing Social Needs in Health Care Settings: Current Approaches in the Obstetric and…”