This article is more than 5 years old. Information may no longer be current.
Misdiagnosis likely in patients with slipped capital femoral epiphysis
Multiple primary care contacts with relevant symptomatology were thought to account for some diagnostic delays.
Click Here to Manage Email Alerts
A strong association was seen between slipped capital femoral epiphysis, area-level socioeconomic deprivation and pre-disease obesity in a study. Investigators identified that children presenting with knee or thigh pain, rather than hip pain, contributed to pediatric patients being less likely to be promptly diagnosed with slipped capital femoral epiphysis.
Daniel C. Perry, MB ChB(Hons), PhD, FHEA, FRCS (Tr & Orth), and colleagues identified 596 patients younger than 16 years of age with a diagnosis of slipped capital femoral epiphysis (SCFE) from 650 primary care practices in the United Kingdom between 1990 and 2013. Main outcomes included annual incidence, missed opportunities for diagnosis and diagnostic delay.
Results showed an overall annual rate of 4.8 SCFE cases per 100,000 individuals who were up to 16-year-olds during the 23-year period studied.
Perry and his colleagues noted SCFE had a strong association with socioeconomic deprivation and pre-disease obesity. According to results, 75.4% of patients had multiple primary care contacts with relevant symptomatology, which made diagnostic delays common.
“Frontline physicians need to be especially alert to hip or knee pain amongst overweight and obese adolescents, which may indicate slipped capital femoral epiphysis,” Perry told Orthopedics Today.
Although previous research has demonstrated evident delays among children who present with knee pain, it was interesting to see this across a population basis, said Perry, who is a National Institute for Health Research Clinician Scientist and consultant in children’s orthopedic surgery at Alder Hey Children’s Hospital, in Liverpool, UK.
“I would love to see a true population cohort (ie, not a health care population cohort) amongst whom BMI has been routinely recorded in children,” Perry said. “We could then look for the causal association between obesity and SCFE, ie, dose response and a temporal relationship,” he said. – by Casey Tingle
Reference:
Perry DC, et al. Arch Dis Child. 2017;doi:10.1136/archdischild-2016-312328.
For more information:
Daniel C. Perry, MB ChB(Hons), PhD, FHEA, FRCS (Tr & Orth), can be reached at Institute of Translational Medicine, University of Liverpool, Liverpool, L12 2AP, UK; email: d.c.perry@liverpool.ac.uk.
Disclosure: Perry reports no relevant financial disclosures.
Perspective
Back to Top
Alvin Howell Crawford, MD, Hon Causa Gr, FACS
This is the first study to examine the epidemiology of SCFE using linked primary and secondary care records. It is excellent and should be available for primary care practitioners, pediatricians and musculoskeletal care providers, including surgeons and non-surgeons in training to raise awareness and ensure prompt recognition and referral of patients. The major tenets of obesity, pre-determined hip pain, knee pain, altered gait and miscellaneous leg pain are spot on in drawing attention to this disorder.
The high morbidity to the patient, possibility of early hip replacement, and this being a major source of litigation to practitioners and hospitals are societal issues of great significance. This new age of open access publications would allow the authors the opportunity to supplement their excellent study with on-line publications for practitioners, as well as hospital urgent and emergent centers. They can extol the value of thorough investigation of the hips for all children, including those who are socioeconomically deprived and present with these major tenets, and so other conditions can also be ruled out. For SCFE, this would eliminate the experience of being called to an operating room where a knee arthroscopy is attempting to be performed, but the patient’s leg will not fit into the stirrups, or consulted when hip radiographs revealing SCFE.
Click Here to Manage Email Alerts