Doctor's delay in diagnosis of slipped capital femoral epiphysis

Slipped capital femoral epiphysis (SCFE) is one of the most common hip disorders in the adolescent child. The primary treatment is acute epiphysiodesis. Diffuse symptomology seems to delay diagnosis and delayed treatment entails a risk of complications. Via the independent Danish Patient Insurance Association (DPIA), Danish patients have been able to file a claim when an unexpected side effect or injury has resulted from their medical treatment. The DPIA is based on a no-blame, no-fault case evaluation, which is free of charge and without any legal action. We wanted to examine the causes of complaints through closed claim analysis.

In the DPIA, all medical statements and internal DPIA notes are stored and available for detailed scrutiny. Cases from 1996 to 2011 were investigated for treatment failures.

A total of 40 cases were included. The mean age of the children was 12.4 years. A doctor's delay (DD) of the diagnosis was found in 27 case files, with an average 181-day delay. The education and specialisation of the doctors responsible was diverse. Often orthopaedic surgeons would make the correct diagnosis. Complications to surgery were found in 16 cases. In all, 22 of the 40 cases were economially compensated, 16 cases were categorised as "severe disability" by the DPIA.

This study used closed claim analysis to determine that DD might result in a deteriorated treatment result in children with SCFE. Hopefully, awareness of the disease may lead to an earlier correct diagnosis and hence improve the outcome for the child.

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