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Patient factors associated with delayed diagnosis of developmental dysplasia of the hip
A W Lindberg1,2, V Bompadre2, E K Satchell3
1Seattle Children's Hospital - Department of Orthopaedics and Sports Medicine, 4800 Sandpoint Way NE M/S MB.10.620, Seattle, WA 98105, USA.
Insights
Delayed diagnosis of developmental dysplasia of the hip (DDH) is linked to birth presentation, not race or socioeconomic status. Further research is needed to improve early detection and treatment for all infants.
Area of Science:
- Pediatric Orthopedics
- Developmental Biology
- Public Health
Background:
- Early detection and intervention are crucial for normal hip development in infants with developmental dysplasia of the hip (DDH).
- Previous research indicates disparities in accessing pediatric specialty care based on race and socioeconomic factors.
- Understanding factors influencing timely referral for DDH is essential for equitable healthcare access.
Purpose of the Study:
- To investigate the relationship between demographic and socioeconomic factors and the timeliness of referral for infants diagnosed with DDH.
- To identify specific patient characteristics associated with delayed diagnosis and treatment of DDH.
- To inform strategies for improving early intervention in DDH.
Main Methods:
- A retrospective cohort study reviewed 457 patients treated for DDH between July 2006 and June 2011.
- Patients were categorized into early-presenting (before 6 months) and late-presenting (6 months or older) groups.
- Logistic regression analysis was used to identify factors associated with late presentation.
Main Results:
- Late presentations were significantly more likely to have a vertex birth presentation (85% vs. 41%).
- While bivariate analysis showed associations with non-white race, non-English speaking status, lower income, and public insurance, multivariate analysis identified only vertex birth, absent family history, and affected right side as significant predictors of late presentation.
- Logistic regression revealed vertex birth (p=0.000), absent family history of DDH (p=0.047), and affected right side (p=0.001) as significant factors for late presentation.
Conclusions:
- Despite existing screening protocols, factors beyond race and socioeconomic status, such as birth presentation, significantly influence delayed diagnosis of DDH.
- Further research is required to understand the complex interplay of demographic and socioeconomic factors in accessing pediatric orthopedic care for DDH.
- Improving early detection and treatment rates for DDH necessitates a deeper understanding of barriers to timely care.
Purpose:
Early detection and intervention for developmental dysplasia of the hip (DDH) is important for normal hip development. Previous studies have shown disparities in access to paediatric specialty care among different racial and socioeconomic backgrounds. This study aims to identify whether these factors are related to timely referral for infants with DDH.
Methods:
A retrospective cohort study of patients seen and treated for DDH between July 2006 and June 2011 at a single institution were reviewed. The patients were divided into early-presenting (seen before six months of age) and late-presenting patients (seen at six months of age or later).
Results:
A total of 457 patients met the eligibility criteria. There were 378 early and 79 late presentations. Late presentations were significantly more likely to be vertex at birth (85% vs 41%, p < 0.001). Bivariate analysis also demonstrated that late presentations were more likely to be non-white (65% vs 45%, p = 0.004), non-English speaking (20% vs 8%, p = 0.003), from lower income areas ($70 769 vs $61 591, p < 0.001) and hold public insurance (25%, p = 0.001). However, a logistic multiple regression analysis showed that only vertex birth presentation (p = 0.000), absent family history of DDH (p = 0.047) and affected right side (p = 0.001) were significantly associated with late presentation.
Conclusion:
Despite screening algorithms to facilitate early diagnosis of infants with DDH, better research is needed to understand how different demographic and socioeconomic factors play into the delayed access to paediatric orthopaedic care for DDH so that we may ultimately improve rates of early treatment.
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