June 18, 2018
2 min read

Misdiagnosis likely in patients with slipped capital femoral epiphysis

Multiple primary care contacts with relevant symptomatology were thought to account for some diagnostic delays.

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A strong association was seen between slipped capital femoral epiphysis, area-level socioeconomic deprivation and pre-disease obesity in a study. Investigators identified that children presenting with knee or thigh pain, rather than hip pain, contributed to pediatric patients being less likely to be promptly diagnosed with slipped capital femoral epiphysis.

Daniel C. Perry

Daniel C. Perry, MB ChB(Hons), PhD, FHEA, FRCS (Tr & Orth), and colleagues identified 596 patients younger than 16 years of age with a diagnosis of slipped capital femoral epiphysis (SCFE) from 650 primary care practices in the United Kingdom between 1990 and 2013. Main outcomes included annual incidence, missed opportunities for diagnosis and diagnostic delay.

Results showed an overall annual rate of 4.8 SCFE cases per 100,000 individuals who were up to 16-year-olds during the 23-year period studied.

Perry and his colleagues noted SCFE had a strong association with socioeconomic deprivation and pre-disease obesity. According to results, 75.4% of patients had multiple primary care contacts with relevant symptomatology, which made diagnostic delays common.

A frog-lateral image of the hips of a 12-year-old obese child demonstrates the deformity in the left hip that is typical of a SCFE.
Source: Daniel C. Perry, MB ChB(Hons), PhD, FHEA, FRCS (Tr & Orth)

“Frontline physicians need to be especially alert to hip or knee pain amongst overweight and obese adolescents, which may indicate slipped capital femoral epiphysis,” Perry told Orthopedics Today.

Although previous research has demonstrated evident delays among children who present with knee pain, it was interesting to see this across a population basis, said Perry, who is a National Institute for Health Research Clinician Scientist and consultant in children’s orthopedic surgery at Alder Hey Children’s Hospital, in Liverpool, UK.

“I would love to see a true population cohort (ie, not a health care population cohort) amongst whom BMI has been routinely recorded in children,” Perry said. “We could then look for the causal association between obesity and SCFE, ie, dose response and a temporal relationship,” he said. – by Casey Tingle


Perry DC, et al. Arch Dis Child. 2017;doi:10.1136/archdischild-2016-312328.

For more information:

Daniel C. Perry, MB ChB(Hons), PhD, FHEA, FRCS (Tr & Orth), can be reached at Institute of Translational Medicine, University of Liverpool, Liverpool, L12 2AP, UK; email: d.c.perry@liverpool.ac.uk.

Disclosure: Perry reports no relevant financial disclosures.