title: Continuing Delay in the Diagnosis of Slipped Capital Femoral Epiphysis.
abstract: To evaluate whether the time from symptom onset to diagnosis of slipped capital femoral epiphysis (SCFE) has improved over a recent decade compared with reports of previous decades.
  
  
  
  Retrospective review of 481 patients admitted with a diagnosis of SCFE at three large pediatric hospitals between January 2003 and December 2012.
  
  
  
  The average time from symptom onset to diagnosis of SCFE was 17 weeks (range, 0-to 169). There were no significant differences in time from symptom onset to diagnosis across 2-year intervals of the 10-year study period (P = .94). The time from evaluation by first provider to diagnosis was significantly shorter for patients evaluated at an orthopedic clinic (mean, 0 weeks; range, 0-0 weeks) compared with patients evaluated by a primary care provider (mean, 4 weeks; range, 0-52 weeks; r = 0.24; P = .003) or at an emergency department (mean, 6 weeks, range, 0-104 weeks; r = 0.36; P = .008). Fifty-two patients (10.8%) developed a second SCFE after treatment of the first affected side. The time from the onset of symptoms to diagnosis for the second episode of SCFE was significantly shorter (r = 0.19; P < .001), with mean interval of 11 weeks (range, 0-104 weeks) from symptom onset to diagnosis. There were significantly more cases of mildly severe SCFE, as defined by the Wilson classification scheme, in second episodes of SCFE compared with first episodes of SCFE (OR, 4.44; P = .001).
  
  
  
  Despite reports documenting a lag in time to the diagnosis of SCFE more than a decade ago, there has been no improvement in the speed of diagnosis. Decreases in both the time to diagnosis and the severity of findings for the second episode of SCFE suggest that the education of at-risk children and their families (or providers) may be of benefit in decreasing this delay.
authors.affiliation: Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Schur
authors.affiliation: Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Andras
authors.affiliation: Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Broom
authors.affiliation: Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Kody K
authors.initials: KK
authors.lastname: Barrett
authors.affiliation: Department of Orthopedic Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Bowman
authors.affiliation: Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Herman
authors.initials: H
authors.lastname: Luther
authors.affiliation: Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Rachel Y
authors.initials: RY
authors.lastname: Goldstein
authors.affiliation: Department of Orthopedic Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Fletcher
authors.affiliation: Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Millis
authors.affiliation: Department of Orthopedic Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Robert
authors.initials: R
authors.lastname: Runner
authors.affiliation: Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA. Electronic address: dskaggs@chla.usc.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D060048:Slipped Capital Femoral Epiphyses / Q000175:diagnosis*; D013997:Time Factors; D014481:United States
keywords: no improvement in delay in diagnosis; second slipped capital femoral epiphysis