Slipped upper femoral epiphysis (SUFE)

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    The list below includes common traumatic injuries that require referral to emergency and should not be referred for elective / fracture clinic categorisation

    Paediatric

    Limping child/reluctant to weight bear

    • Limping child with signs of:
      • Being unwell, flushed, lethargic, fever, flat, anorexic and/or
      • Irritable and stiff joint and/or
      • Not improving
    • Systemically unwell, febrile or suspicion of septic arthritis
    • Concern of infection or trauma
    • Suspicion or concern of non-accidental injury

    Heel Pain

    • Systemically unwell, febrile or suspicion of septic arthritis
    • Concern of infection or trauma
    • Suspicion or concern of non-accidental injury

    Osgood-Schlatter Disease

    • Suspected infection or bone disease

    Perthes Disease

    • For guidelines regarding when to refer to emergency, please see HealthPathways.
    • Systemically unwell, febrile or suspicion of septic arthritis
    • Concern of infection or trauma

    Slipped upper femoral epiphysis (SUFE)

    • All suspected or confirmed SUFE should be referred to the ED or local orthopaedic on call registrar service no matter the chronicity

    Scoliosis / Kyphosis

    • Systemically unwell
    • Abnormal neurological reason

    Back pain

    • Systemically unwell
    • Abnormal neurological reason

    Tumour – bone and soft tissue

    • Suspected malignancy

    Infection: bone/joint

    • If clinically confirmed or suspected bone infection who present with;
      • fever
      • unexplained limp and/or abnormal posture or gait
      • reluctance to use the limb or will not weight bear if lower limb affected
      • musculoskeletal pain ± presence of local bone or joint tenderness, swelling or erythema
      • complete or partial limitation of movement on examination.
    • All cases with pain, or abnormal labs or abnormal bone scan
    • Refer to local HealthPathways or local guidelines
    • Ensure patient is non-weight bearing on affected side with bilateral crutches
    • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
    • Statement of intent – the prioritisation of health services for children and young people in the child protection system
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service

NB: All new SUFE diagnosis/suspicions are ACUTE
Category 2
(appointment within 90 calendar days)
  • Post treatment with pain or disability
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Clinical history and examination including key points: -
    • evolution and duration of symptoms
    • treatment prescribed (analgesics)
    • current and past medical history and medications, Anthropometry
    • relevant family history associated with SUFE
  • XR plain AP pelvis and frog leg lateral both hips
  • Confirmation of OOHC (Where appropriate)

3. Additional referral information Useful for processing the referral

  • No additional referral information

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 28 August 2024

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