title: Delay in diagnosis of slipped capital femoral epiphysis.
abstract: OBJECTIVE
  Delay in diagnosis of slipped capital femoral epiphysis (SCFE) has important implications in terms of slip severity and long-term hip outcome. The purpose of this study was to identify predictors of delay in the diagnosis of SCFE.
  
  
  METHODS
  A review of 196 patients with SCFE was performed. The primary outcome measure was delay from onset of symptoms to diagnosis. Covariates included age, gender, side, weight, pain location, insurance status, family income, slip severity, and slip stability. Delay in diagnosis was not normal in distribution; therefore, nonparametric univariate and multivariate analyses were performed.
  
  
  RESULTS
  The median delay in diagnosis was 8.0 weeks. There was a significant relationship between delay in diagnosis and slip severity (<30 degrees : 10.0 weeks; 30 degrees to 50 degrees : 14.4 weeks; >50 degrees : 20.6 weeks). There were no significant associations between delay in diagnosis and covariates of age, gender, side, and weight. There were significant associations between longer delay in diagnosis and covariates of knee/distal-thigh pain versus hip/proximal-thigh pain (6.0 vs 15.0 weeks), Medicaid coverage versus private insurance (12.0 vs 7.5 weeks), lower family income, and stable slips versus unstable slips (8.0 vs 6.5 weeks). Controlling for the other covariates, knee/distal-thigh pain, Medicaid insurance, and stable slips remained significant independent multivariate predictors of delay in diagnosis.
  
  
  CONCLUSIONS
  Patients who present with primarily knee or distal-thigh pain, patients with Medicaid coverage, and patients with stable slips have longer delays in diagnosis of SCFE. Focused intervention programs to reduce the delay in diagnosis of SCFE should emphasize patients with knee/thigh pain and patients with Medicaid coverage.
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. mininder.kocher@childrens.harvard.edu
authors.forename: Mininder S
authors.initials: MS
authors.lastname: Kocher
authors.forename: Julius A
authors.initials: JA
authors.lastname: Bishop
authors.forename: Bryce
authors.initials: B
authors.lastname: Weed
authors.forename: M Timothy
authors.initials: MT
authors.lastname: Hresko
authors.forename: Michael B
authors.initials: MB
authors.lastname: Millis
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: James R
authors.initials: JR
authors.lastname: Kasser
mesh_terms: D002648:Child; D003951:Diagnostic Errors; D004839:Epiphyses, Slipped / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005270:Femur Head; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology; D018709:Statistics, Nonparametric