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[Screening for dysplasia of the hip at health centers]
Per Lagerløv1, Kristin Bakke, Ellen Merete Hogstad
1St. Hanshaugen Helsestasjon Pilestredet 56 0167 Oslo. per.lagerlov@netcom.no
Insights
Screening for developmental dysplasia of the hip using clinical tests in Norwegian health centers has a low positive predictive value. Asymmetric abduction, a common referral reason, rarely indicates hip dysplasia.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
Background:
- Developmental dysplasia of the hip (DDH) screening is standard practice in Norwegian health centers.
- Current guidelines emphasize asymmetric abduction as the primary referral criterion for hip ultrasound.
Purpose of the Study:
- To evaluate the effectiveness of current screening practices for DDH in infants.
- To determine the outcome and predictive value of ultrasound referrals from health centers.
Main Methods:
- Prospective study of all hip ultrasounds performed in 2000 at two Norwegian hospitals.
- Analysis of referral indications and examination outcomes for children from health centers.
Main Results:
- An estimated prevalence of 0.5 per 1,000 children with DDH was found.
- Asymmetric abduction had a low positive predictive value (3%) for DDH.
- Asymmetric skin folds also showed a low positive predictive value, with some cases of DDH identified.
Conclusions:
- Clinical screening criteria for DDH, including asymmetric abduction, exhibit low positive predictive values.
- Current screening methods may lead to unnecessary referrals and examinations.
Background:
Screening for developmental dysplasia of the hip has a long tradition in health centres in Norway. Under the guidelines from Norwegian health authorities, the presence of asymmetric abduction of the hips should be the most important indication for referral to ultrasound examination. The outcome of this procedure is not well known, however.
Material And Methods:
Throughout the year 2000, all children referred for ultrasound examination of their hips to Ullevaal University Hospital and Oppland Central Hospital Lillehammer were recorded prospectively. The indication for and outcome of the examination of children referred from health centres were examined.
Results:
133 girls and 92 boys were referred. Three girls and three boys were identified with dysplasia of the hip, giving an estimated prevalence of 0.5 pr 1,000. Asymmetric abduction of the hip was the most frequent reason for referral with an estimated positive predictive value of 3%. 50 children were examined due to asymmetric femoral skin folds that were probably the only reason for suspecting dysplasia. Two of these children had dysplasia of the hip. 16 children had immature hips necessitating renewed examination, often identifying normal hips.
Interpretation:
The screening for developmental dysplasia of the hip at health centres is based on clinical tests or criteria with low positive predictive values.
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