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Clinical screening for developmental dysplasia of the hip in Northern Ireland
S L Maxwell1, A L Ruiz, K J Lappin
1Musculoskeletal Education and Research Unit, Musgrave Park Hospital, Belfast BT9 7JB. lorrainemaxwell@hotmail.com
Insights
Improving screening for developmental dysplasia of the hip (DDH) significantly reduced late diagnoses. Early detection efforts are crucial, especially for infants with risk factors, to further lower surgical intervention rates.
Area of Science:
- Orthopedics
- Pediatric Health
- Public Health Screening
Background:
- High incidence of late-diagnosed developmental dysplasia of the hip (DDH) requiring surgery in Northern Ireland.
- Previous incidence reported at 1.14 per 1000 children (1983-7).
Purpose of the Study:
- To evaluate the impact of enhanced screening strategies on reducing late diagnoses of DDH.
- To decrease the rate of operative intervention for DDH detected after six months of age.
Main Methods:
- Comparative retrospective study of clinical screening programs in Northern Ireland.
- Implementation of increased staff training, a centralized nurse-led clinic, and expanded ultrasonography use.
- Key measure: Reduction in operative interventions for DDH diagnosed after six months.
Main Results:
- Incidence of DDH diagnosed after six months decreased to 0.59 per 1000 children (1991-7).
- Despite improvements, 16% of affected hips were not diagnosed at initial referral (first 3 months).
- 27 affected hips (diagnosed after six months) had known risk factors like family history or breech delivery.
Conclusions:
- Enhanced screening processes demonstrably reduce the late incidence of DDH.
- Further improvements in detecting DDH in infants with risk factors and at initial referral are needed to minimize late presentations.
Problem:
The incidence of late diagnosed developmental dysplasia of the hip requiring surgery in Northern Ireland is high. The reported incidence was 1.14 per 1000 children born during 1983-7.
Design:
Comparative retrospective study.
Background And Setting:
Clinical screening programme in Northern Ireland. Key measure for improvement: Reduced rate of operative intervention in children with developmental dysplasia of the hip detected after 6 months of age.
Strategies For Change:
Increased emphasis on staff training, introduction of a centralised nurse led clinic to improve access to orthopaedic surgeons, and increased use of ultrasonography.
Effects Of Change:
The incidence of developmental dysplasia of the hip diagnosed after 6 months in children born between January 1991 and December 1997 fell to 0.59 per 1000, presumably due to improved early detection. Nevertheless, 29 (16%) of the affected hips were not diagnosed when the child was first referred in the first 3 months of life. In addition, for 27 affected hips in children diagnosed after the age of 6 months there was a known risk factor (family history or breech delivery).
Lessons Learnt:
Improvements to screening processes can reduce late incidence of developmental dysplasia of the hip. Further steps to improve detection in children with known risk factors and rate of detection at first referral could reduce late presentation further.
