A nationwide cohort study of slipped capital femoral epiphysis

Abstract

ObjectivesTo describe the epidemiology of slipped capital femoral epiphysis (SCFE), to examine associations with childhood obesity and socioeconomic deprivation, and to explore factors associated with diagnostic delays.DesignHistoric cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink and Hospital Episode Statistics.SettingAll contacts with healthcare services, including emergency presentations, outpatient appointments, inpatient admissions and primary care visits, within the UK National Health Service.PatientsAll individuals <16 years old with a diagnosis of SCFE and whose electronic medical record was held by one of 650 primary care practices in the UK between 1990 and 2013.Main outcome measuresAnnual incidence, missed opportunities for diagnosis and diagnostic delay.ResultsOver the 23-year period the incidence remained constant at 4.8 (95% CI 4.4 to 5.2) cases per 100,000 0–16-year-olds. There was a strong association with socioeconomic deprivation. Predisease obesity was also strongly associated with SCFE; mean predisease z-score of body mass index was 1.43 (95% CI 1.20 to 1.68) compared with the UK reference mean. Diagnostic delays were common, with most children (75.4%) having multiple primary care contacts with relevant symptomatology, and those who presented with knee pain having significantly longer diagnostic delay (median 161 (IQR 27–278) days) than those with hip pain (20 (5–126)) or gait abnormalities (21 (7–72)).ConclusionsSCFE has a strong association with both area-level socioeconomic deprivation and predisease obesity. The majority of patients with SCFE are initially misdiagnosed and those presenting with knee pain are particularly at risk.

A consensus exercise identifying priorities for research into clinical effectiveness among children’s orthopaedic surgeons in the United Kingdom

“…18 This large collaborative of children's surgeons has also embarked on other work to enhance the feasibility of clinical trials, such as the development of core outcome sets and the use of routinely collected data to inform the development of trials. 19 The study has limitations. Invitations to participate in the survey were sent to members of BSCOS, yet surgeons do not have to be members to treat children; this is particularly the case in trauma.…”

Epifisiolistesis femoral proximal

“…La epifisiolistesis femoral proximal es el desplazamiento de la epífisis sobre la metáfisis femoral proximal en la zona hipertrófica de la fisis o cartílago de crecimiento. [1][2][3][4] Es la alteración de la cadera más común en los adolescentes, con incidencia global estimada en 1 de cada 1000 a 1 de cada 10,000 pacientes; 5,6 el principal factor de riesgo es la obesidad, 7 que aumenta en 1-650 casos para obesidad y 1-450 para obesidad severa. 8 El 60% de los pacientes afectados se encuentra por arriba del percentil 90 para el género y la edad; sin embargo, la enfermedad es más frecuente en hombres que en mujeres (1.5:1) y el lado izquierdo suele ser el más afectado.…”

“…Esta alteración es excepcional en pacientes menores de 10 y mayores de 16 años. 6 Otros factores de riesgo incluyen: hipotiroidismo, deficiencia de la hormona de crecimiento, antecedente de radiación y trastornos genéticos (trisomía 21). [9][10][11][12]…”

Differenzialdiagnostik nicht-entzündlicher Gelenkschmerzen/-schwellungen bei Kindern und Jugendlichen

“…Die Femurepiphysiolyse (im amerikanischen Sprachgebrauch ‚Slipped Capital Femoral Epiphysis', SCFE) findet sich häufiger bei übergewichtigen Kindern, v. a. männlichen Jugendlichen [11]. In ca.…”