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Diagnostic yield of sonography in infants with suspected hip dysplasia: diagnostic thinking efficiency and
Elizabeth Ashby1, Andreas Roposch
11 Both authors: Department of Orthopaedic Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK.
Insights
Hip sonography significantly improves diagnostic confidence and alters management plans for infants with suspected developmental dysplasia of the hip (DDH). This imaging tool refines clinical decisions, changing diagnoses in over half of cases.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Medical Decision Making
Background:
- Developmental dysplasia of the hip (DDH) requires accurate and timely diagnosis in infants.
- Clinical assessment alone can have limitations in definitively diagnosing DDH.
- Sonography offers a non-invasive imaging modality for evaluating infant hips.
Purpose of the Study:
- To evaluate the impact of sonographic findings on surgeons' diagnostic reasoning for infant DDH.
- To assess how sonography influences management decisions in suspected DDH cases.
- To quantify changes in diagnostic confidence following ultrasound examination.
Main Methods:
- Five orthopedic surgeons assessed 66 infant hips with suspected DDH.
- Surgeons reported diagnostic confidence using a visual analog scale (VAS) before and after sonography.
- Management plans were recorded, and changes were analyzed to determine therapeutic efficiency.
Main Results:
- Sonography resulted in a change of diagnosis for 52% of hips evaluated.
- Management plans were altered in 32% of cases following sonographic examination.
- Mean diagnostic confidence increased by 19.4%, with a significantly higher gain (46.0%) when management changed.
Conclusions:
- Hip sonography effectively refines diagnostic thinking in clinicians managing infant DDH.
- Ultrasound imaging leads to significant diagnostic and therapeutic adjustments in a substantial proportion of cases.
- Sonography can obviate the need for further follow-up in some infants, streamlining care.
Objective:
The purpose of this study is to determine the impact of sonographic information on surgeons' diagnostic thinking and decision making in the management of infants with a possible diagnosis of developmental dysplasia of the hip (DDH).
Subjects And Methods:
Five experienced orthopedic surgeons examined 66 hips of infants who were referred for a possible diagnosis of DDH and reported for each hip a confidence level about the diagnosis of DDH using a visual analog scale (VAS) before and after hip sonography was obtained. In addition, they reported a management plan. We determined the efficiency in diagnostic thinking by calculating the mean gain in diagnostic confidence as the percentage change in VAS scores and the impact of sonography on the management plan (therapeutic efficiency).
Results:
Sonography led to a change in diagnosis in 52% (34/66) of hips. The management plan changed in 32% (21/66) of hips. The mean gain in reported diagnostic confidence was 19.4% (95% CI, 17.3-21.5%), but it was 46.0% (95% CI, 30.5-60.8%) in cases where the management changed as a result of sonography (difference, 37.7%; p < 0.0001). The greatest yield of sonography was found in hips showing limited abduction. Sonography obviated further follow-up in 23% (15/66) of cases.
Conclusion:
Sonography refined the diagnostic thinking of clinicians and led to a change in diagnosis in 52% of cases. Management plans changed in 32% of cases.
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