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Examining the effectiveness of examination at 6-8 weeks for developmental dysplasia: testing the safety net
Mike Reidy1, Caitlin Collins1, Jamie G B MacLean2
1Trauma and Orthopaedic Department, Ninewells Hospital, Dundee, UK.
Insights
The 6-8 week GP check for developmental dysplasia of the hip (DDH) is not a reliable screening tool, missing four out of five cases. This highlights a critical gap in early detection for infant hip conditions.
Area of Science:
- Pediatric Orthopedics
- Public Health Surveillance
Background:
- Developmental dysplasia of the hip (DDH) requires early detection for non-invasive treatment.
- The UK's 6-8 week 'GP check' is part of the selective surveillance system for DDH.
- Effective early identification is crucial to prevent surgical intervention.
Purpose of the Study:
- To evaluate the effectiveness of the 6-8 week hip examination in identifying developmental dysplasia of the hip (DDH).
- To assess the sensitivity, specificity, and predictive value of the 6-8 week check for DDH.
Main Methods:
- A longitudinal observational study of infants born over a 5-year period.
- Analysis of treatment records for early (<14 weeks) and late (>14 weeks) DDH presentations.
- Review of ultrasound referrals and attendance at the 6-8 week examination for late DDH cases.
Main Results:
- The 6-8 week examination had a sensitivity of 19.4% and a positive predictive value of 1.5%.
- Out of 141 DDH cases, only 6 were identified by the 6-8 week check.
- 25 out of 27 late DDH presentations (88.9%) had attended the 6-8 week check without abnormality detection.
Conclusions:
- The 6-8 week GP check is an unreliable method for detecting developmental dysplasia of the hip (DDH).
- The current examination fails to identify a significant majority of infants with DDH.
- The presumed safety net function of the 6-8 week check is not effective.
Objective:
The 'GP check' at 6-8 weeks forms part of the selective surveillance system for developmental dysplasia of the hip (DDH) in the UK. It is imperative to pick up DDH within the first months of life to allow for non-invasive treatment and the avoidance of surgery. We aim to investigate the effectiveness of hip examination at 6-8 weeks.
Methods:
This is a longitudinal observational study including all infants born in our region in the 5 years following 2006. Early presentation was defined as diagnosis within 14 weeks of birth and late presentation after 14 weeks. Treatment records for early and late DDH as well as referrals for ultrasound (US) following examination at 6-8 weeks were analysed. Attendance of the examination at 6-8 weeks in those patients who went on to present with a late DDH was also analysed.
Results:
23 112 live births occurred during the study period. There were 141 confirmed cases of DDH. 400 referrals for US were received following examination at 6-8 weeks; 6 of these had a positive finding of DDH. 27 patients presented after 14 weeks and were classified as late presentations. 25 of these patients had attended examination at 6-8 weeks and no abnormality had been identified.
Conclusions:
The sensitivity of examination at 6-8 weeks was only 19.4%, its specificity was 98% and it had a positive predictive value of 1.5%. For many years the check at 6-8 weeks has been thought of as a means to identify those children not identified as neonates; however, we found that four out of five children with DDH were not identified by the check at 6-8 weeks. Unfortunately, we conclude that the presumed safety net of the examination in its current form is not reliable.
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