Indiana University School of Medicine, Indianapolis, IN.
J Pediatr Orthop. 2022 Apr 1;42(4):e324-e330. doi: 10.1097/BPO.0000000000002075.
The time to diagnosis in stable slipped capital femoral epiphysis (SCFE) is often several months because of nebulous history, symptoms of knee/thigh pain, and Medicaid insurance. This study examined the impact of socioeconomic status and demographics on the time to diagnosis and SCFE severity in Indiana children.
A retrospective review of all patients at a tertiary children's hospital with SCFE from January 2010 through March 2021 was performed. Standard demographic data and type of insurance was collected. Neighborhood Atlas Mapping was used to determine the state decile of the area deprivation index (ADI), a measure of socioeconomic status using 17 variables related to income, employment, education, and housing. Statistical analyses consisted of standard univariate and bivariate analyses; logistic regression analysis was used to determine predictors of a mild SCFE. A P<0.05 was considered statistically significant.
There were 142 patients; 81 male and 61 female. The average age was 12.2±1.7 years, lateral epiphyseal shaft angle of 35±19 degrees, and symptom duration of 4.5±5.0 months. There was no correlation between ADI state deciles and lateral epiphyseal shaft angle (r2=0.008) or symptom duration (r2=0.019). Insurance status and race differed by ADI deciles. In the first decile (least disadvantaged), 44% had government insurance and 89% were White; in the 10th decile (most disadvantaged), 95% had government insurance and 38% were White. Predictors of a mild SCFE were female sex [odds ratio (OR): 3.2 [1.5, 7.0]; P=0.004], symptom duration <3 months [OR: 5.3 (2.4, 11.7); P=0.00004], and White race [OR: 2.4 (1.3, 6.2); P=0.01]. Insurance status and ADI were not significant.
Contrary to other studies, neither insurance or socioeconomic status were associated with a delay in diagnosis or SCFE severity. The symptom duration in children with SCFE does not appear to be decreasing over the last several decades. Further investigation is required as to why.
Level III-retrospective comparative study.
稳定型股骨头骨骺滑脱（SCFE）的诊断时间通常为数月，因为其病史模糊、膝关节/大腿疼痛的症状以及医疗补助保险。本研究旨在探讨印第安纳州儿童的社会经济地位和人口统计学特征对诊断时间和 SCFE 严重程度的影响。
对 2010 年 1 月至 2021 年 3 月在一家三级儿童医院接受 SCFE 治疗的所有患者进行回顾性分析。收集了标准的人口统计学数据和保险类型。采用社区图谱映射法确定了区域剥夺指数（ADI）的州十分位数，ADI 是一种衡量社会经济地位的指标，使用了与收入、就业、教育和住房相关的 17 个变量。统计分析包括标准的单变量和双变量分析；逻辑回归分析用于确定轻度 SCFE 的预测因素。P<0.05 被认为具有统计学意义。
共纳入 142 例患者，男 81 例，女 61 例。平均年龄为 12.2±1.7 岁，外侧骺干角为 35±19 度，症状持续时间为 4.5±5.0 个月。ADI 州十分位数与外侧骺干角（r2=0.008）或症状持续时间（r2=0.019）之间均无相关性。保险状况和种族因 ADI 十分位数而不同。在第一十分位数（最不利的十分位数）中，44%的患者有政府保险，89%为白人；在第十十分位数（最有利的十分位数）中，95%的患者有政府保险，38%为白人。轻度 SCFE 的预测因素为女性[比值比（OR）：3.2（1.5，7.0）；P=0.004]、症状持续时间<3 个月[OR：5.3（2.4，11.7）；P=0.00004]和白人种族[OR：2.4（1.3，6.2）；P=0.01]。保险状况和 ADI 无统计学意义。
与其他研究不同的是，保险或社会经济地位均与诊断时间延迟或 SCFE 严重程度无关。在过去几十年中，SCFE 患儿的症状持续时间似乎并没有减少。需要进一步调查原因。
III 级-回顾性比较研究。
