Perry Daniel C, Metcalfe David, Costa Matthew L, Van Staa Tjeerd
Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
Arch Dis Child. 2017 Dec;102(12):1132-1136. doi: 10.1136/archdischild-2016-312328. Epub 2017 Jun 29.
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.
Historic cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink and Hospital Episode Statistics.
All contacts with healthcare services, including emergency presentations, outpatient appointments, inpatient admissions and primary care visits, within the UK National Health Service.
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.
Annual incidence, missed opportunities for diagnosis and diagnostic delay.
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)).
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.
描述股骨头骨骺滑脱（SCFE）的流行病学特征，研究其与儿童肥胖及社会经济剥夺的关联，并探讨与诊断延迟相关的因素。
利用临床实践研究数据链和医院事件统计中的初级和二级医疗数据进行的历史性队列研究。
英国国家医疗服务体系内所有与医疗服务的接触，包括急诊就诊、门诊预约、住院治疗和初级医疗就诊。
1990年至2013年间，英国650家初级医疗诊所中，所有诊断为SCFE且年龄小于16岁并拥有电子病历的个体。
年发病率、诊断错失机会和诊断延迟。
在这23年期间，每10万名0至16岁儿童中的发病率保持恒定，为4.8例（95%可信区间4.4至5.2）。与社会经济剥夺密切相关。疾病前期肥胖也与SCFE密切相关；与英国参考均值相比，疾病前期体重指数的平均z评分为1.43（95%可信区间1.20至1.68）。诊断延迟很常见，大多数儿童（75.4%）有多次与相关症状的初级医疗接触，出现膝关节疼痛的儿童诊断延迟明显更长（中位数161天（四分位间距27至278天）），而出现髋关节疼痛的儿童诊断延迟为20天（5至126天），步态异常的儿童诊断延迟为21天（7至72天）。
SCFE与地区层面的社会经济剥夺和疾病前期肥胖均密切相关。大多数SCFE患者最初被误诊，出现膝关节疼痛的患者尤其危险。
