A Pilot Study on Resident and Pediatrician Knowledge and Confidence in the Diagnosis of Slipped Capital Femoral Epiphysis

Abstract

Introduction. The purpose of this study was to identify deficiencies in pediatric residents' and pediatricians' knowledge and confidence in diagnosing slipped capital femoral epiphysis (SCFE). Methods. Pediatricians and residents at our institution answered an anonymous 12-question survey on knowledge and confidence in SCFE diagnosis. Results. Twenty pediatricians and 30 pediatric residents participated in the survey. Of 30 residents, 22 (77%) reported low confidence ordering radiographs evaluating for SCFE in patients with hip pain. Four of 20 pediatricians (20%) reported low confidence ordering radiographs for patients with hip pain. Forty percent (8/20) of pediatricians did not feel comfortable diagnosing a SCFE based on radiographs, which was significantly different from 80% (24/30) of residents who did not feel comfortable diagnosing a SCFE based on radiographs (P = .004). There was a significant difference between residents and pediatricians in comfort ordering and diagnosing radiographs (P < .01). There was no significance between pediatrician and resident scores for knowledge-based questions (P = .50). Discussion. Despite scoring well on knowledge-based questions, more than half of pediatricians and pediatric residents felt uncomfortable ordering radiographs to evaluate for SCFE in patients with hip or knee pain. This may be one factor contributing to the continued delay in SCFE diagnosis.

Keywords: delay diagnosis; pediatric hip pain; slipped capital femoral epiphysis.

Figure 1.

Participating resident demographics. Reproduced with permission from Children’s Orthoapedic Center, Los Angeles.

Figure 2.

Percent of correct responses for knowledge-based survey questions among residents and pediatrician. Reproduced with permission from Children’s Orthoapedic Center, Los Angeles.

Figure 3.

Comfort of Ordering Radiographs with patients presenting with hip or knee pain. Percentage of survey respondents who feel comfortable with diagnosing slipped capital femoral epiphysis based on clinical examination and imaging. Pediatricians were significantly more comfortable ordering diagnostic radiographs for patient with hip or knee pain compared with residents (*P < .001). Reproduced with permission from Children’s Orthopedic Center, Los Angeles.