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Estimated effect of secondary screening for hip dislocation
Daniel Wenger1,2, Carl Johan Tiderius3,2, Henrik Düppe3,2
1Department of Orthopaedics, Skåne University Hospital, Lund and Malmö, Sweden daniel.wenger@med.lu.se.
Insights
Secondary screening for hip dislocations significantly reduces diagnostic age and severity in children. This approach identified half of late-diagnosed cases, lowering severe hip dislocation risk by 27%.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
- Public Health Screening
Background:
- Late diagnosis of hip dislocations in children is associated with increased severity and poorer outcomes.
- Early detection through screening programs is crucial for effective management of developmental dysplasia of the hip.
Purpose of the Study:
- To evaluate the impact of secondary screening on the age at diagnosis and disease severity of hip dislocations.
- To quantify the effectiveness of secondary screening in identifying cases missed by primary screening.
Main Methods:
- Retrospective analysis of a nationwide registry of children diagnosed with hip dislocations.
- Comparison of outcomes between children diagnosed via secondary screening and those presenting with symptoms.
Main Results:
- Children diagnosed through secondary screening were 11 months younger at diagnosis compared to symptomatic cases.
- Secondary screening reduced the risk of severe hip dislocation by 27% (absolute risk reduction).
- Secondary screening identified 55% of children with late-presenting hip dislocations not detected by primary screening.
Conclusions:
- Secondary screening at child healthcare centers significantly lowers the age of diagnosis for hip dislocations.
- Implementing secondary screening can substantially decrease the severity of hip dislocations in children.
- This screening strategy is effective in identifying a significant proportion of missed hip dislocation cases.
Objectives:
To quantify the effect of secondary screening for hip dislocations.
Design:
Retrospective analysis of hospital files from participants in a prospectively collected nationwide registry.
Setting:
Child healthcare centres and orthopaedic departments in Sweden.
Participants:
Of 126 children with hip dislocation diagnosed later than 14 days age in the 2000-2009 birth cohort, 101 had complete data and were included in the study.
Interventions:
The entire birth cohort was subject to clinical screening for hip instability at 6-8 weeks, 6 months and 10-12 months age. Children diagnosed through this screening were compared with children presenting due to symptoms, which was used as a surrogate variable representing a situation without secondary screening.
Main Outcome Measures:
Age at diagnosis and disease severity of late presenting hip dislocations.
Results:
Children diagnosed through secondary screening were 11 months younger (median: 47 weeks) compared with those presenting with symptoms (p<0.001). Children diagnosed through secondary screening had 11% risk of having a high (severe) dislocation, compared with 38% for those diagnosed due to symptoms; absolute risk reduction 27% (95% CI: 9.7% to 45%), relative risk 0.28 (95% CI: 0.11 to 0.70). Children presenting due to symptoms had OR 5.1 (95% CI: 1.7 to 15) of having a high dislocation, and OR 11 (95% CI: 4.1 to 31) of presenting at age 1 year or older, compared with the secondary screening group. The secondary screening was able to identify half of the children (55%, 95% CI: 45% to 66%) not diagnosed through primary screening.
Conclusions:
Secondary screening at child healthcare centres may have substantially lowered the age at diagnosis in half of all children with late presenting hip dislocation not diagnosed through primary screening, with the risk of having a high dislocation decreased almost to one-quarter in such cases.
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