AOFAS On the Same Page: Inequities in Pediatric Care-SCFE

SCFE

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The study investigates the factors contributing to delayed diagnosis of slipped capital femoral epiphysis (SCFE), a common adolescent hip condition. While existing literature highlights the complications of delayed SCFE diagnosis, this research specifically examines the impact of social determinants like insurance type, family structure, and neighborhood-level socioeconomic vulnerability on diagnostic delay.

Analysis was conducted on 351 patients who received surgical treatment for stable SCFE from 2002 to 2021. Factors like insurance status, family structure, and social vulnerability index (SVI) were assessed. Key findings indicate that:

1. <strong>Insurance Type</strong>: Publicly insured patients were 83% more likely to experience a delay of over 12 weeks in diagnosis compared to those with private insurance.
   
2. <strong>Family Structure</strong>: Children from single-guardian households had a 95% higher likelihood of delayed diagnosis compared to those from multiguardian households. The results suggest a link between limited resources/access and diagnostic delays.

3. <strong>Neighborhood Socioeconomic Factors</strong>: There was no significant delay correlation with high SVI, indicating that this aspect may not independently predict diagnostic delays.

Additional findings revealed that delays were also associated with younger age at presentation and obesity. Contrary to previous studies, physician specialty at initial presentation (orthopedic surgeons) also correlated with longer delays, perhaps due to initial primary care misdiagnosis or referral system inefficiencies.

In conclusion, the study underscores public insurance and single-guardian households as factors independently contributing to SCFE diagnostic delays, suggesting targeted interventions to improve timely diagnosis. Despite prior efforts, these delays persist, underscoring the need for better practitioner education and systemic adjustments to address social determinants of health impacting SCFE care.

Keywords

SCFE

delayed diagnosis

adolescent hip condition

insurance type

family structure

socioeconomic vulnerability

public insurance

single-guardian households

diagnostic delays

social determinants