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Demographic Predictors of Severity of Stable Slipped Capital Femoral Epiphyses
Randall T. Loder, MD1; Trevor Starnes, MD, PhD2; Greg Dikos, MD1; David D. Aronsson, MD3
1 James Whitcomb Riley Hospital for Children, 702 Barnhill Drive, Room 4250, Indianapolis, IN 46202. E-mail address for R.T. Loder: rloder@iupui.edu
2 Department of Orthopaedic Surgery, University of Virginia, Charlottes-ville, VA 22908
3 Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, 434B Stafford Hall, Burlington, VT 05405
View Disclosures and Other Information
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Garceau Professorship Endowment, Department of Orthopaedic Surgery, Indiana University School of Medicine, and the George Rapp Pediatric Orthopaedic Research Endowment, Riley Children's Foundation, Indianapolis, Indiana. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the James Whitcomb Riley Hospital for Children, Indianapolis, Indiana; C.S. Mott Children's Hospital, Ann Arbor, Michigan; and Children's Hospital of Michigan, Detroit, Michigan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Jan 01;88(1):97-105. doi: 10.2106/JBJS.E.00069
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Background: The outcome of stable slipped capital femoral epiphysis is directly related to the severity of the slip. If it is assumed that the slip will be less severe if it is diagnosed early, then early diagnosis should improve the prognosis. It was our purpose to determine demographic predictors of the severity of a slipped capital femoral epiphysis.

Methods: A retrospective study of 243 children with a total of 328 stable slipped capital femoral epiphyses was performed. Gender, race, age, and symptom duration were noted. Slip severity was classified as mild (<30°), moderate (30° to 50°), or severe (>50°). Statistical analyses included bivariate, multivariate, linear correlation, and logistic regression techniques.

Results: There were 159 boys and eighty-four girls; 149 children had unilateral and ninety-four had bilateral slipped capital femoral epiphysis. Of the bilateral slips, forty-two were simultaneous and fifty-two were sequential. The mean age (and standard deviation) was 12.6 ± 1.8 years, the mean duration of the symptoms was 5.2 ± 7.4 months, and the mean slip angle was 29° ± 20°. There were 199 mild, sixty-eight moderate, and forty-five severe slips. The mean duration of symptoms was 3.5 ± 5.0 months for the mild slips, 7.7 ± 9.0 months for the moderate slips, and 8.8 ± 10.6 months for the severe slips (p < 0.0001). Older children had more severe slips: the average age was 12.3 ± 1.8 years for the children with a mild slip, 13.0 ± 1.6 years for those with a moderate slip, and 13.8 ± 1.8 years for those with a severe slip (p < 0.0001). Multivariate analyses demonstrated that, among the factors studied, only the age of the patient and the duration of the symptoms were associated with the slip severity. Symptom duration and patient age were used as predictors of slip severity in a logistic regression analysis, with =30° and <30° used as the categories for slip severity, older than 12.5 years old compared with 12.5 years old or younger used as the categories for age, and more than 2.0 months compared with 2.0 months or less used as the categories for symptom duration. This model predicted the probability of a slip with confidence (p < 0.0001). The odds ratios (with 95% confidence intervals) for age and symptom duration were 2.0 (1.15 to 3.53) and 4.1 (2.34 to 7.12), respectively. Thus, a child with a stable slipped capital femoral epiphysis is 2.0 times more likely to have a moderate or severe slip if he or she is older than 12.5 years of age at the time of the diagnosis and 4.1 times more likely to have a moderate or severe slip if the duration of symptoms was longer than two months.

Conclusions: The only two known significant predictors of the severity of a slipped capital femoral epiphysis are age at diagnosis and symptom duration. For any individual child, slip severity and symptom duration are unique; in a large population, there is a general correlation between slip severity and increases in patient age and increases in the duration of symptoms.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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