Litigation involving patients with slipped capital femoral epiphysis

Background: Slipped capital femoral epiphysis (SCFE) is a hip disorder of late childhood and adolescence. Liti-gation involving SCFE may occur, as it is frequently diagnosed late, and/or may be temporally related to an injury. The purpose of this study was to review litigation cases involving SCFE in the US, focusing on the type of litigation (professional, premise, or product liability), the outcome of the litigation and indemnity payouts.Methods: Cases of litigation involving SCFE were identified using 5 legal databases and Google Scholar searching for the term "slipped capital femoral epiphysis". These databases originated as early as 1973. The data collected was the alleged complaint, type of defendant, outcome, state where filed, and amount of indemnity payout. Payout amounts were converted to 2020 US$. Statistical analyses were performed with SYSTAT (R) 10 software.Results: There were 135 unique cases identified which involved professional liability (103), premise liability (30), both premise and professional liability (1), and product liability (1). Complaints for professional liability cases were alleged failure in diagnosis (71), inappropriate treatment (14), both diagnosis and treatment (12), and others (7). The delay in those with an alleged late diagnosis (37 cases) was 5.8 months. The three most common specialties named as defendant(s) were primary care (31%), orthopaedic surgeons (29%), and radiologists (16%). The primary allegations against non-orthopaedic surgeons were failure in diagnosis (89%) as opposed to or-thopaedic surgeons where the complaints of alleged failures in diagnosis and inappropriate treatment were equal (50%). The geographic region of the filed cases was the Northeast (44%), South (24%), Midwest (16%), and West (16%). There were no differences between premise and professional liability cases by geographic region. The overall outcome was favorable for the defendant(s) in 53% and the plaintiff in 47%; the defense prevailed in 60% of the professional liability but only 33% of the premise liability cases. The indemnity payout amount (for the 52 cases where known) averaged $1.28 million. Payout was higher in the complaints for professional compared to premise liability ($1.5 vs. $0.9 million). The average payout for those with and without avascular necrosis was $2.97 million vs. $1.02 million. For the professional liability claims, indemnity payout was most frequent in the Western US. It must be remembered that this study only represents law suits filed in the US court system. It does not include cases that might have been resolved prior to any legal action as those cases are not publicly available.Conclusions: Reported litigation involving SCFE patients involved claims of professional liability in 77% and premise liability in 22% of located cases. Due to significant exposure, this study should serve as a reminder to all health care providers to include SCFE in the differential diagnosis of knee/thigh pain in adolescents.