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.
Slipped upper femoral epiphysis (SUFE) is a disorder of the paediatric and adolescent hip. It is characterised by displacement of the upper femoral epiphysis from the metaphysis through the physis (Figure 1, Table 1). Internationally, reports of the incidence of this condition vary between 0.2 per 100 000 and 10 per 100 000.1,3 Prompt diagnosis and management is important as delayed diagnosis is known to be associated with poorer long term outcomes.1–4
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