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Division of Emergency Medicine, Harvard Medical School, Children's Hospital, Boston, MA 02115.
Prompt diagnosis of slipped capital femoral epiphysis (SCFE) is dependent on recognition of variable clinical manifestations. The charts of 116 children and adolescents with SCFE were reviewed to identify characteristics of patients whose diagnosis was initially missed. Missed diagnosis was found in 34 patients (29%). Sixteen of the 34 whose diagnosis was missed had hip pain, while 58 of the 82 whose diagnosis was not missed had hip pain (P = .0157). Of the 34 patients with missed diagnosis, 15 patients had thigh pain. In comparison, of the 82 patients without missed diagnosis, 19 had thigh pain (P = .0241). It is concluded that SCFE is more likely to be missed at the initial visit if hip pain is absent or if thigh pain is present. This review indicates that despite the evidence that patients with SCFE frequently complain of symptoms other than hip pain, the disorder continues to be missed.
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