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A nationwide cohort study of slipped capital femoral epiphysis
  1. Daniel C Perry1,
  2. David Metcalfe2,
  3. Matthew L Costa2,
  4. Tjeerd Van Staa3
  1. 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  2. 2 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
  3. 3 Health eResearch Centre, University of Manchester, Manchester, UK
  1. Correspondence to Dr Daniel C Perry, Institute of Translational Medicine, University of Liverpool, Liverpool, L12 2AP, UK; danperry{at}liverpool.ac.uk

Abstract

Objectives To describe the epidemiology of slipped capital femoral epiphysis (SCFE), to examine associations with childhood obesity and socioeconomic deprivation, and to explore factors associated with diagnostic delays.

Design Historic cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink and Hospital Episode Statistics.

Setting All contacts with healthcare services, including emergency presentations, outpatient appointments, inpatient admissions and primary care visits, within the UK National Health Service.

Patients All individuals <16 years old with a diagnosis of SCFE and whose electronic medical record was held by one of 650 primary care practices in the UK between 1990 and 2013.

Main outcome measures Annual incidence, missed opportunities for diagnosis and diagnostic delay.

Results Over the 23-year period the incidence remained constant at 4.8 (95% CI 4.4 to 5.2) cases per 100,000 0–16-year-olds. There was a strong association with socioeconomic deprivation. Predisease obesity was also strongly associated with SCFE; mean predisease z-score of body mass index was 1.43 (95% CI 1.20 to 1.68) compared with the UK reference mean. Diagnostic delays were common, with most children (75.4%) having multiple primary care contacts with relevant symptomatology, and those who presented with knee pain having significantly longer diagnostic delay (median 161 (IQR 27–278) days) than those with hip pain (20 (5–126)) or gait abnormalities (21 (7–72)).

Conclusions SCFE has a strong association with both area-level socioeconomic deprivation and predisease obesity. The majority of patients with SCFE are initially misdiagnosed and those presenting with knee pain are particularly at risk.

  • delayed diagnosis
  • misdiagnosis
  • descriptive epidemiology
  • slipped capital femoral epiphyses

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors DCP conceived the study, undertook the data analysis and drafted the manuscript. DM contributed to the study design, data analysis and drafting of the manuscript. MLC and TVS contributed to the study design, helped interpret the data and made important critical revisions to the manuscript.

  • Funding This work was supported by the Academy of Medical Sciences Starter Grants for Clinical Lecturers (cofunded awards from the Academy, Wellcome Trust, Medical Research Council, British Heart Foundation, Arthritis Research UK, the Royal College of Physicians and Diabetes UK). DCP is funded by a National Institute for Health Research as an NIHR Clinician Scientist.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Pursuant to the terms of our data sharing agreement with the data owners, no additional data are available from the corresponding author. Further data may be available on application directly to NHS Digital.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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