Delayed Diagnosis of Developmental Dysplasia of the Hip, Slipped Capital Femoral Epiphysis, and Legg-Calve-Perthes Disease in British Columbia

Objective: The objective of this scoping review is to understand the extent and type of evidence in relation to factors influencing delayed diagnosis in Slipped capital femoral epiphysis (SCFE), developmental dysplasia of the hip (DDH), and Legg-Calvé-Perthes Disease (LCPD). Introduction: Slipped capital femoral epiphysis (SCFE), developmental dysplasia of the hip (DDH), and Legg-Calvé-Perthes Disease (LCPD) are three of the most common childhood hip disorders (Yagdiran et al., 2020). Incidence rates lie at 660, 0.3-25, and 10 per 100,000 for DDH, SCFE, and LCPD respectively. Incidence rates vary significantly due to several factors including race, ethnicity, country, and socioeconomic status (SES) (Pollet et al., 2017; Loder & Skopelja, 2011; Bratio et al., 2021). The delayed diagnosis of DDH, SCFE, and LCPD has been examined in the past. Previous studies have found that a delayed diagnosis of DDH was more likely in patients with a vertex birth, where non-white, non-english speaking families, from lower income areas, and in areas without a universal screening program (Lindberg et al., 2017; Donnelly et al., 2015). Research examining the time from symptom onset to diagnosis of patients presenting with SCFE has shown a mean delay range of 64 to 181 days in patients with SCFE (Greene et al., 2005; Pihl et al., 2014; Samelis et al., 2020). Delays in diagnosis were associated with the type of healthcare specialist visited, the type of pain patients initially presented with where initial presentations of knee pain were associated with significant delays, type of imaging ordered, and SES (Phil et al., 2014; Hosseinzadeh et al., 2017; Samelis et al., 2020; Kocker et al., 2004). Less information is available on the delayed diagnosis of LCPD. However, one chart review of 57 patients in Hong Kong showed that delayed diagnosis and presentation with painless limb and stiffness were common (Wang et al., 1990). Currently, studies have focused on each disorder individually and there has been a lack of work done at Canadian hospitals to identify potential delays in diagnosis of DDH, SCFE and LCPD. Additionally there is a lack of information on patient perspectives when it comes to the diagnosis of these conditions. Inclusion criteria: We included articles that discussed the incidence of delayed diagnosis of DDH, SCFE or LCPD in pediatric populations. Methods: We will search MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCO) for articles published after 1997 with full text available in English. Studies were selected if they discussed DDH, SCFE or LCPD risk factors or incidence of delayed diagnosis. Data extraction will be carried out, with population age, population size, incidence of delay, and risk factors being some major variables we plan to collect. We will then analyze the evidence and present the results.

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