Delay in the Diagnosis of Stable Slipped Capital Femoral Epiphysis

Hosseinzadeh, Pooya; Iwinski, Henry J.; Salava, Jonathon; Oeffinger, Donna

doi:10.1097/bpo.0000000000000665

Cited by 27 publications

(36 citation statements)

References 10 publications

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“…Green et al 7 evaluated the primary care system, which included the emergency department, urgent care setting and paediatricians, and found that in 102 patients, the average delay from their first visit with a primary care provider to the time of admission was 10.0 weeks. Hosseinzadeh et al 11 found in their series of 149 patients, that patients presenting to orthopaedic surgeons had a 0.4 week delay in a SCFE diagnosis compared with 13.4 weeks when the patient presented to non-orthopaedic providers. Similarly, Schur et al 10 reported that in their study of 481 patients, the time from first evaluation to diagnosis was significantly shorter for patients evaluated at an orthopaedic clinic (0 weeks) than patients evaluated by a primary care provider (four weeks) or at an emergency department (six weeks).…”

Section: Discussionmentioning

confidence: 99%

“…Although the time from symptom onset to first physician visit was identified as a major contributor to the delay, this cannot be altered by clinicians. 11 However, healthcare providers can help decrease the time from the first visit to diagnosis. Several studies have reported on the impact that healthcare provider specialty has on delayed diagnosis of a SCFE.…”

Section: Discussionmentioning

confidence: 99%

“…An initial presentation of knee or distal thigh pain is also associated with a significant delay of a SCFE diagnosis. 8 , 11 Frequently, only radiographic images of the knees are ordered. Even when the initial examining physician screens the affected hips, reports have showed that only AP radiographs are ordered sometimes.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosing slipped capital femoral epiphysis amongst various medical specialists

Lam

Boenerjous

et al. 2018

Journal of Children's Orthopaedics

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PurposeTo evaluate sensitivity, specificity and accuracy of a radiographic slipped capital femoral epiphysis (SCFE)-diagnosis among medical specialists.MethodsThree paediatricians, three paediatric radiologists and three paediatric orthopaedic surgeons completed two rounds of a survey of anteroposterior and frog-leg lateral radiographs of patients with a diagnosis of SCFE (25), femoroacetabular impingement (four), Legg-Calvé-Perthes (11) or no hip pathology (ten). Intra- and interobserver agreement among specialties regarding the diagnosis of a SCFE were assessed using Cohen’s kappa coefficient (κ). Diagnostic accuracy of SCFE relative to the benchmark, a combination of the radiographic diagnosis based on Klein’s line, clinical symptoms and surgical treatment, was assessed computing sensitivity, specificity and accuracy.ResultsIntraobserver agreement between the surveys was moderate among paediatricians (κ-range, 0.44 to 0.52), moderate to almost perfect among orthopaedic surgeons (κ-range, 0.79 to 0.88) and almost perfect among paediatric radiologists (κ-range, 0.83 to 1.00). Interobserver agreement for survey 1 and 2 was slight among paediatricians (mean κ, 0.19), substantial among orthopaedic surgeons (mean κ, 0.77) and almost perfect among paediatric radiologists (mean κ, 0.86). Sensitivity of SCFE-diagnosis was high among radiologists and orthopaedic surgeons (88% to 100% for both specialties), but lower for paediatricians (24% to 76%). Specificity was high among radiologists and orthopaedic surgeons (72% to 84%), however, variable among paediatricians (56% to 80%). Accuracy of a SCFE-diagnosis was highest in radiologists (84% to 92%), followed by orthopaedic surgeons (80% to 88%) and paediatricians (48% to 78%).ConclusionSCFE can be detected on radiographs by different medical specialties. Intra- and interobserver agreement, specificity, sensitivity and accuracy for radiographic SCFE-diagnosis amongst paediatric radiologists and orthopaedic surgeons are better than that of general paediatricians.Level of EvidenceII

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diagnosing slipped capital femoral epiphysis amongst various medical specialists

Lam

Boenerjous

et al. 2018

Journal of Children's Orthopaedics

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“…Non-orthopedics are more prone not to diagnose a slip during the first examination of the patient [29]. Physicians must be aware of the rare conditions of the hip that may cause a limp.…”

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

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“…El envío al ortopedista pediatra debe efectuase tan pronto como se tenga la sospecha o se haya establecido el diagnóstico, pues el retraso en el tratamiento se asocia con mal pronóstico, debido al alto riesgo de osteonecrosis de la cabeza femoral. 19,13…”

Section: Intervención Del Especialistaunclassified

Epifisiolistesis femoral proximal

et al. 2019

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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.1-4 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. La edad media para los hombres es de 13.5 años (cuando no han alcanzado el estadio IV de Tanner) y para las mujeres de 12 años, sin menarquia. 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).9-12

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Delay in the Diagnosis of Stable Slipped Capital Femoral Epiphysis

Abstract: Level III-prognostic.

Cited by 27 publications

References 10 publications

Diagnosing slipped capital femoral epiphysis amongst various medical specialists

Diagnosing slipped capital femoral epiphysis amongst various medical specialists

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

Epifisiolistesis femoral proximal

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