Slipped capital femoral epiphysis: Diagnosis in a primary care setting

May 1987

ABSTRACTS

%JPPEIl O.PI%-AL pRblC4AL SPIPHYSIS: DIAGNOSIS IN I,. R0DSE.PI.D.. L.J. D’ANGElD,H.D.,M.P.H.

PSYCIIOSOCIAL ISSUES IN AWLESCI:NT PIKLNANCY AMONG ,NWK:,,,N~.SI: REFUGEES. Murranoe S. IFel ice. %.‘I. ,G.Pa”l SbraSQ,.A., ?,,rbv, 1,. James. M.U.. and Uororhy Ilollingsuor~h, M.D. Dryarrmc”rh ot

SSTrING.

AMLESCENP ANO YOUNG

, and

Pedutrirs. Clinlc”l Kesvarch Cc”~r*r Kvpruducl, Y<’ Mrdlcr II,.. IICSD School of Mediclnt~ and Mcd,cal Crn~rr, Sas D,ego, cA The purpose of lhis descriprlvc rrpor~ in IU dlcr~ cll”lc~,,n L,, rhck psychosocial progems 01 Indocbinesc prcgaant LccnogPrs. ‘rIxn I”doc,,,,,rsc pregnilnl wens (X aeu 16.6 years + 0.‘17 ywrh) YL’TP followed n‘ 1, Univ,rs,~y Tee” OU CLinic rncludi”R > Vretnilmc~s~, ‘3 IBULLJOB, 3 Cambodlass. and

I

Hnong.

The pregnant months + 23) prior girls were enrolled

Liens hpd resided in rho USA for 3-72 ~nonths (r 30 to cancrplion. Nine “f the ten were primigravrdas. I-our in school at regisLr”tios for ~rcna~+l carv. The f”thers of Abe infants were older Lhun Lhe preg”s”t wcns (Y “ge 23.d years + 3.4): only 2 couples WXP married ot ~unception. six of the I0 girls WLW &r living uiLh a “aLural parc”L or husbund. a”d 3 grrle bad R parart kimd ur sLlll Inrssing 1” Lhrlr “alive counwy. L‘lvr temiliea 01 Lhe 8 u”m.lrrwd CL’CIIS enpwssed deep shnme of 0% girl’s prrg”a”cy and in 4 cilhw 11~. garls acre socially punished by Lomiliill rejccrlo” and/or expulrlon. In splrc ol L,IL’ sb”mc. ,,o Indocbl”cs~ Lrc” chose LO udopr o”t her infanr. IL appear> ~h”r unmurried ~wnag~ prcR”““cy is not acccp~~blc in Induchinesc cufrura, groups and young wome” from Lhwu u~bnic groups who become pregnanr may bc under exrraordinary f”mIli.ll swcsh.

N*SHINmN.

Baltlmora, Plnrylnnd. HQ(LLLh cnre provldora b”c no wnluutlo”

ochool-based cl‘nics to thaw enpsriancas examine

hns bocn C”RO reports

rapnrt of rhc Tbo

publisbsd. fr”m seven

rcwnrding eiD”iEica”t purpose

ExpErioncen in Inctor” contributl”S ot

this

study

is

to

solicited school-based adolescc”t Clinics located in a” urban setting in order to idcntlly chorscteristica OF eftactive health care delivery in school-based clinles. Nurse prsctitioner~ from each clinic BubmILted monthly woe reports describing one or more examples of evnluation and case “rano~cment which they coneidcred to be pnrticulnrly lifectlve in terms of improved adolescent hcnlth. The cane ruporrs were reporcrd end to describe

effectiveness. Adoleacenrs

Three with

revfeued to decerminr ED”!~o” faaura xbic,,

types

n chronic

of clinic01 illnesa

or

the typea of clinical EU” be used to ovaluatc

problems need

such

were “8

reported:

asrbmn

or

problsmn

(1) controceptio”;

(2) Generally healthy odolwcsnte with abnormal orrccnlng test results ‘or pr”tei”UrI., scoliosis or enemls; (3) Adolerrconrs uith attendnnee. lcorni”~ or behavior problame. Co”m~oonfactors were idcntiftcd whlcb nrs rolstw, to rhc key of school-hosed clinic twccess, I.e. location. This Pcnturc lo divldcd into the qpeci‘ic f~ctoro of accsssibllity for the “t”de”t. occsssibility far the hculth care Provider to directly co”toct the student. accessibility for collsborntivc interaction bcruao” th. ncboo, nt”fI and clinic 8tatr. ““d the need for rope.ltnd clinic vitlit~. The EDHI. report Prcncntetior hlOhltghts the factors which Poc,,iL”te tho m,,n.?Dem~nt of WC,, typ aof clintcol problem. For example, the staged. Progrcusive evuluotion of a” nbnormal scroeni”~ rest resolves the d,~$nostic question with minimal t‘mc lost from school and minimal expense. The relotianablp bcruce” the effecriveness f”ctors B”d men~ures of Improved odolrscenc hoolth will be in”rsriSared in future proop~ctivf studies.

fouture

HED.,

CHIlDKm’S

A

PRIMY

Cm

DEPT.

HOSP. NAT.

OT

HErI.

CNTR..

D.C.

Slipped CaPital femoral epiphyais ISWET) occors most frequently in You”9 adolescents. Diagnosis soon after onset of *ymPtoms influences eventoal outcome. I” a” effort to detaxmine characteristics which coold aesist in making a correct early diagnosis. we campared cases diagnosed at first Presentation versus those in which the diagnosis was delayed. We ~eerospectively revieued records of 57 patients eee” over a 15 year period in Primary care settings i” our institution. Of the 57 patients. 39 were males f66W and 19 were f-lea 03%). vbe mer,” age in males WB 14 Yearn and in females was 12.5 years. Trauma and obesity were each reported in 43.81 of all Patients. Gait. ab”Ormalities were present in 43 ,74\, and hip Pain in 37 i65W. Eighteen. Patients (ll.SIl had heen seen on one ar more Prior cccasi”“ns with complaint* suggestive of SCFS. There were no significant differences between tbif

group

and

tlnae

diagnosed

at

initial

Preaentstion

in

age

(13.3

years

for

delayed diagnosis “ers”B 13 Yearn for initial diagnosis). sex, length of Pain (15 w?elle for delayed diagnosis versus 17 weeks for initial disagncaiaI.locetion of Pain 161% hip Pain for delayed dla9nosis V~L‘BUD66, for initial diagnosis), findings on Physical exam (77% decreased hip internal rotation for delayed diaqnosis WXBYB 9% for initial diagnoaia). history of tr.wx”a 1551 for delayed diaO”osis versus 38% for initial diagnoaisl. or obesity (508 in delayed dianosis versus 419 in aind aymPtomn sug9ast the diagnoals af SCPE. Pri~ty CUB physicians should ho fJmi1iar with then” and. when Prc~enc~ evaluste with this diarlnooio in mind,

Carcain eigna

SC,,DUI..,IASB” ADOLESCBNT CLlNlCS - EFFECTIVENESS FACTORS IDBNTIFIE,, IN CASE REPORTS, Lonl 5mitb Majer, M.D., Dept. of Padi”Wica, The Johns llophlnu University School of Medicine,

ADULT

313

initial diagnoslal.