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Published on: February 2, 2015
Effectiveness of ultrasound screening for developmental dysplasia of the hip
E A Roovers1, M M Boere-Boonekamp, R M Castelein
1University of Twente, PO Box 217, Enschede 7500 AE, the Netherlands.
Insights
Ultrasound screening for developmental dysplasia of the hip (DDH) in infants is more effective than standard physical exams, detecting more cases earlier. However, it may lead to overtreatment in some instances.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Public Health Screening
Background:
- Developmental dysplasia of the hip (DDH) is a condition requiring early detection for effective treatment.
- Current screening methods, like child health care centre (CHC) physical examinations, may miss cases or detect them late.
Purpose of the Study:
- To evaluate the effectiveness of ultrasound screening for DDH in infants after the neonatal period.
- To compare ultrasound screening with routine CHC physical examination screening.
Main Methods:
- A prospective cohort study involving infants attending child health care centres.
- Intervention group (n=5170) received ultrasound screening at 1, 2, and 3 months.
- Control group (n=2066) received routine physical examination (CHC screening).
- All infants received a follow-up ultrasound at 6 months to assess screening accuracy.
Main Results:
- Ultrasound screening demonstrated higher sensitivity (88.5%) compared to CHC screening (76.4%).
- Ultrasound screening resulted in a lower referral rate (7.6%) versus CHC screening (19.2%).
- A higher proportion of infants in the ultrasound group were referred earlier (before 13 weeks) than in the CHC group (67% vs 29%).
- The treatment rate was higher in the ultrasound group (4.6%) compared to the CHC group (2.7%), potentially indicating overtreatment.
Conclusions:
- Ultrasound screening is more effective than CHC screening for detecting DDH in infants, identifying more cases at an earlier age.
- While ultrasound screening improves early detection, it may not completely eliminate late-diagnosed DDH.
- The increased treatment rate in the ultrasound group warrants consideration for potential overtreatment.
Objective:
To determine the effectiveness of ultrasound screening for developmental dysplasia of the hip (DDH) after the neonatal period.
Design:
Prospective cohort study.
Setting:
Child health care centres.
Participants:
Infants attending the child health care centres.
Interventions:
The intervention group (n = 5170) was screened by ultrasound at 1, 2, and 3 months of age. The control group (n = 2066) was screened by routine physical examination as part of the programme for child health surveillance at the child health care centres (CHC screening). For evaluation of the screening, the children in both the intervention and control group received an ultrasound examination after 6 months of age to detect any abnormality that might have been missed by the screening.
Results:
The sensitivity of the ultrasound screening was 88.5%, and the referral rate 7.6%. As a result of the ultrasound screening, 4.6% of the children were treated. The sensitivity of the CHC screening was 76.4%, with a referral rate of 19.2%. The treatment rate was 2.7%. Of the treated children in the ultrasound screening group, 67% were referred before the age of 13 weeks, whereas in the CHC screening group only 29% were referred before this age.
Conclusions:
This study shows that ultrasound screening detects more children with DDH than CHC screening and that more of them are detected at an earlier age. To accomplish this, even fewer children have to be referred. However, even general ultrasound screening seems not to eradicate late cases of DDH. The higher treatment rate in the population screened by ultrasound may be a result of overtreatment.
