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Standardized Process Measures in Radiographic Hip Surveillance for Children with Cerebral Palsy
Kathryn S Milks1,2, Erin L Mesi1, Amanda T Whitaker3,4
1Fromt the Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Standardizing hip surveillance for children with cerebral palsy (CP) using Migration Percentage (MP) improved early detection of hip dislocation risk. This quality improvement initiative enhanced communication and patient outcomes.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Quality Improvement
Background:
- Hip migration in children with cerebral palsy (CP) requires radiographic surveillance to prevent dislocations.
- Migration Percentage (MP) is the standard metric for quantifying hip subluxation on pelvis X-rays in CP.
- Lack of consistent MP reporting hindered effective hip surveillance at the institution.
Purpose of the Study:
- To standardize radiographic techniques for hip surveillance in children with CP.
- To implement structured reporting of MP and dislocation risk categories.
- To improve the early detection and management of hip subluxation in this population.
Main Methods:
- Retrospective review of baseline CP surveillance X-ray reports.
- Education of radiologists and technologists on standardized imaging techniques.
- Implementation of a structured reporting template including MP measurement and risk stratification.
- Tracking reporting compliance and assessing image/report quality.
Main Results:
- Achieved and sustained approximately 90% reporting compliance within 5 months.
- Newly diagnosed 89% of children with high-risk hips during the study period, all showing progressive MP increase.
- Clinicians found the standardized reports, including MP, beneficial for practice.
Conclusions:
- Standardized hip surveillance using quality improvement methodology enhances care for children with CP.
- Radiology reports with MP and risk category facilitate interdisciplinary communication.
- Early detection and treatment through standardized reporting lead to better patient outcomes.
Abstract:
Detection of hip migration in children with cerebral palsy (CP) through radiographic surveillance can prevent dislocations. Migration Percentage (MP) is the accepted method for quantifying hip subluxation in CP on pelvis x-ray but was not being reported at our institution. Our objective was to improve care for children with CP by standardizing radiographic techniques and reporting radiographs obtained as part of a hip surveillance program.
Methods:
A baseline retrospective review of CP surveillance pelvis x-ray reports was performed. We then educated radiologists and technologists, standardized imaging techniques, and required structured radiology reporting to include MP measurement and dislocation risk categories. We tracked compliance with the reporting template for 10 months. Images and reports were also assessed for quality and accuracy by an orthopedic surgeon.
Results:
Baseline period reports showed no consistency. In total, 449 children with CP (mean age: 7.3 years ± 4.2) had a surveillance pelvis radiograph during the postintervention study period (May 2019-February 2020). An estimated 90% reporting compliance was achieved and sustained by 5 months. Eight (89%) of the children with high-risk hips were newly diagnosed during our study period; all had a progressive increase in MP from prior examinations. All clinicians surveyed agreed that the standardized reports, including MP, were helpful to their practice.
Conclusions:
Using evidence-based process measures and quality improvement methodology, we standardized hip surveillance for children with CP. Radiology reports that include MP and risk category for hip dislocation enable clear communication for referrals across specialties and early detection and treatment for better outcomes.
