Demographic predictors of severity of stable slipped capital femoral epiphyses.
BACKGROUND
The outcome of stable slipped capital femoral epiphysis is directly related to the severity of the slip. If it is assumed that the slip will be less severe if it is diagnosed early, then early diagnosis should improve the prognosis. It was our purpose to determine demographic predictors of the severity of a slipped capital femoral epiphysis.


METHODS
A retrospective study of 243 children with a total of 328 stable slipped capital femoral epiphyses was performed. Gender, race, age, and symptom duration were noted. Slip severity was classified as mild (<30 degrees ), moderate (30 degrees to 50 degrees ), or severe (>50 degrees ). Statistical analyses included bivariate, multivariate, linear correlation, and logistic regression techniques.


RESULTS
There were 159 boys and eighty-four girls; 149 children had unilateral and ninety-four had bilateral slipped capital femoral epiphysis. Of the bilateral slips, forty-two were simultaneous and fifty-two were sequential. The mean age (and standard deviation) was 12.6 +/- 1.8 years, the mean duration of the symptoms was 5.2 +/- 7.4 months, and the mean slip angle was 29 degrees +/- 20 degrees . There were 199 mild, sixty-eight moderate, and forty-five severe slips. The mean duration of symptoms was 3.5 +/- 5.0 months for the mild slips, 7.7 +/- 9.0 months for the moderate slips, and 8.8 +/- 10.6 months for the severe slips (p < 0.0001). Older children had more severe slips: the average age was 12.3 +/- 1.8 years for the children with a mild slip, 13.0 +/- 1.6 years for those with a moderate slip, and 13.8 +/- 1.8 years for those with a severe slip (p < 0.0001). Multivariate analyses demonstrated that, among the factors studied, only the age of the patient and the duration of the symptoms were associated with the slip severity. Symptom duration and patient age were used as predictors of slip severity in a logistic regression analysis, with > or =30 degrees and <30 degrees used as the categories for slip severity, older than 12.5 years old compared with 12.5 years old or younger used as the categories for age, and more than 2.0 months compared with 2.0 months or less used as the categories for symptom duration. This model predicted the probability of a slip with confidence (p < 0.0001). The odds ratios (with 95% confidence intervals) for age and symptom duration were 2.0 (1.15 to 3.53) and 4.1 (2.34 to 7.12), respectively. Thus, a child with a stable slipped capital femoral epiphysis is 2.0 times more likely to have a moderate or severe slip if he or she is older than 12.5 years of age at the time of the diagnosis and 4.1 times more likely to have a moderate or severe slip if the duration of symptoms was longer than two months.


CONCLUSIONS
The only two known significant predictors of the severity of a slipped capital femoral epiphysis are age at diagnosis and symptom duration. For any individual child, slip severity and symptom duration are unique; in a large population, there is a general correlation between slip severity and increases in patient age and increases in the duration of symptoms.
Loder
Randall T
RT
James Whitcomb Riley Hospital for Children, 702 Barnhill Drive, Room 4250, Indianapolis, IN 46202, USA. rloder@iupui.edu
Starnes
Trevor
T
Dikos
Greg
G
Aronsson
David D
DD
D000293:Adolescent; D000367:Age Factors; D002648:Child; D042241:Early Diagnosis; D004839:Epiphyses, Slipped / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005269:Femur / Q000473:pathology*; D005544:Forecasting; D006801:Humans; D008297:Male; D011379:Prognosis; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome