Slipped upper femoral epiphysis in children--delays to diagnosis

Slipped upper femoral epiphysis (SUFE) is a childhood condition requiring urgent admission for surgery. It is often complicated by delayed diagnosis.

This study investigated incidence and factors contributing to delayed diagnosis of SUFE, by retrospective and prospective review of children (n=120) presenting to a tertiary institution with SUFE from 2003-2007.

The delay from initial presentation to a health professional to hospital admission ranged from 0-731 days. Most patients (76%) presented initially to their general practitioner. Of children with stable SUFE, the diagnosis was missed at the initial consultation in 62 (60%) of 103 children, and there was a delay after X-ray to diagnosis of 0-11 days. There were no delays from hip radiograph to confirmation in patients with unstable SUFE.

A child presenting with hip, thigh or knee pain and reduced hip range of movement (particularly internal rotation) on the affected side, should arouse clinical suspicion of SUFE. This should prompt radiographic imaging of the hip with antero-posterior and lateral hip views. This study shows that most children presenting to The Royal Children's Hospital (Melbourne, Victoria) with SUFE from 2003-2007 presented first to their GP and some faced significant delays to diagnosis and admission. These delays are of concern as delays have been shown to result in increased severity of physeal slip and poorer long term outcomes. General practitioners play a crucial role in the early recognition and diagnosis of SUFE to ensure timely and appropriate referral and the best possible outcome for the child.