title: Consequences of diagnostic delays in slipped capital femoral epiphysis.
abstract: Delay in diagnosis of slipped capital femoral epiphysis has important implications with regard to slip severity and long-term hip outcomes. The aims of this review were to identify the incidence of delayed diagnosis of slipped capital femoral epiphysis in the hospital to which the authors are affiliated, and the causes for such delays. A retrospective review was conducted of all patients admitted to the Women's and Children's Hospital in Adelaide between January 1997 and October 2004 with a diagnosis of slipped capital femoral epiphysis. The inpatient and outpatient medical records for each patient were analysed to clarify the history of presentation and identify those patients with a delayed diagnosis. All radiographs were reviewed and the severity of the slip graded according to Southwick's classification. One hundred and two patients were included in this review, of which 20 had a delayed diagnosis and 25 a late presentation. Of the 20 (19.6%) patients who had a delayed diagnosis in this series, a minimum of 2 weeks elapsed between presentation to a health professional and diagnosis of slipped capital femoral epiphysis. Eight patients had seen their local doctor but the diagnosis was not made. The remaining 12 patients with delayed diagnosis had not seen a medical practitioner and had self-referred to a chiropractor or a physiotherapist. All of these patients underwent hip manipulation prior to diagnosis. There was a significant relationship between delay in diagnosis and an increased slip severity, when compared with both the remainder of this series and the late presentation group. Knee or distal thigh pain in slipped capital femoral epiphysis remains the commonest pitfall in diagnosis for local doctors, as well as mild slips being missed on radiograms by inexperienced surgeons or radiologists. An increasing presentation of adolescents with this disorder to allied health professionals for initial management warrants a broader education strategy than has been previously advocated. Slipped capital femoral epiphysis remains an enigmatic disorder; consequently delayed diagnosis of this condition is not likely to disappear. Despite this, the medical community must strive toward early diagnosis through continued education and vigilance.
authors.affiliation: Women's and Children's Hospital (Adelaide), Sydney, New South Wales, Australia. drahme@optusnet.com.au
authors.forename: Daniel
authors.initials: D
authors.lastname: Rahme
authors.forename: Andrew
authors.initials: A
authors.lastname: Comley
authors.forename: Bruce
authors.initials: B
authors.lastname: Foster
authors.forename: Peter
authors.initials: P
authors.lastname: Cundy
mesh_terms: D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D042241:Early Diagnosis; D004839:Epiphyses, Slipped / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors