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Introducing universal ultrasound screening for developmental dysplasia of the hip doubled the treatment rate
Stine F Olsen1, Hans C Blom2, Karen Rosendahl3,4
1Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway.
Insights
Adding universal ultrasound screening to clinical exams for developmental dysplasia of the hip doubled infant treatment rates. This did not increase late diagnoses in a low-prevalence population.
Area of Science:
- Pediatrics
- Orthopedic Surgery
- Diagnostic Imaging
Background:
- Developmental dysplasia of the hip (DDH) screening lacks evidence for universal ultrasound's impact.
- Clinical screening alone may miss cases in low-prevalence populations.
Purpose of the Study:
- To evaluate the effect of adding ultrasound to clinical screening for DDH.
- To assess changes in treatment rates, follow-up, and late diagnoses.
Main Methods:
- A study of 4245 infants (1998-2006) included clinical and ultrasound hip screening within three days of life.
- Treatment was indicated for positive clinical signs or sonographic dysplasia.
- Data was compared to a prestudy period (1989-1997) of 3594 infants.
Main Results:
- The treatment rate for DDH doubled from 0.9% to 2.1% with the addition of ultrasound screening.
- Follow-up rates remained unchanged at 11%.
- Late diagnoses remained low, with no cases of surgery or avascular necrosis in the first year.
Conclusions:
- Universal ultrasound screening, combined with clinical examination, effectively doubles DDH treatment rates.
- This approach did not negatively impact the low rates of late diagnoses.
Aim:
There is no evidence on the effect of universal ultrasound screening on developmental dysplasia of the hip. We examined the impact of adding an ultrasound examination to a one examiner clinical screening strategy on treatment, follow-up rates and the number of cases detected late in a low-prevalence population.
Methods:
All eligible babies born at Kongsberg Hospital, Norway, from 1998 to 2006 (n = 4245) underwent both clinical and ultrasound hip examinations within three days of life. Indications for immediate treatment were positive Barlow or Ortolani manoeuvres and, or, sonographic dysplasia. Sonographic immature hips were followed until normalisation. Treatment rates and rates from the 1989 to 1997 prestudy period (n = 3594), including late diagnoses, were collected from hospital records.
Results:
Treatment was initiated in 90 (2.1%) infants (74 girls), 63 (70%) from birth, compared to 33 (0.9%) during the prestudy period. The follow-up rate did not change (11%). There were two (0.5/1000) and four (1.0/1000) cases detected late, respectively. No one underwent surgery during the first year of life and no avascular necrosis was seen.
Conclusion:
Adding universal ultrasound to clinical screening performed by the same, experienced paediatrician doubled the treatment rate, without influencing the already low numbers of late cases.
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