title: The delay in diagnosis of slipped capital femoral epiphysis: a review of 102 patients.
abstract: OBJECTIVE
  The aim of this study were (1) to evaluate the incidence of apparent missed diagnosis of slipped capital femoral epiphysis (SCFE) by the primary care system and (2) to identify possible factors leading to a delay in diagnosis of this disorder.
  
  
  METHODS
  A retrospective review of emergency department records, outside medical charts, and preoperative and postoperative radiographs of children treated surgically for SCFE at the Children's Hospital of Los Angeles (CHLA) from 1989 to 1997 was done to assess the delay in diagnosis for SCFE. The primary care system included outside emergency department visits, urgent care clinic visits, and private office visits.
  
  
  RESULTS
  Of 102 patients (69 men, 33 women; mean age at surgery, 11.9 years), 68% were above the 95th percentile mean weight for age. Pain in the hip and/or groin was documented in 60%. The mean duration of symptoms experienced before being seen at CHLA was 140 days (hours to 1.5 years) and the mean delay after the first primary care visit till being seen at CHLA was 76 days (hours to 1 year). Fifty-two percent of primary care visits for hip, groin, knee, or thigh pain in obese children did not lead to either a diagnosis of SCFE or a referral for orthopedic evaluation.
  
  
  CONCLUSIONS
  This study documents a 2 1/2-month delay and a 52% incidence of apparent missed diagnosis for SCFE by the primary care system. There seems to be a need for increased orthopedic education for primary care providers.
authors.affiliation: The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. greendw@hss.edu
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Green
authors.forename: Richard A K
authors.initials: RA
authors.lastname: Reynolds
authors.forename: Safdar N
authors.initials: SN
authors.lastname: Khan
authors.forename: Vernon
authors.initials: V
authors.lastname: Tolo