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Risk factors for misdiagnosis in children with developmental dysplasia of the hip: a retrospective single centre
Zong-Zhi Fan1,2, Ya-Bo Yan1, Jia Sha1
1Department of Orthopedics, Xijing Hospital，Air Force Military Medical University, Xian, Shaanxi, China.
Insights
Children with developmental dysplasia of the hip (DDH) without screening are often misdiagnosed. Physician
Area of Science:
- Pediatric Orthopedics
- Diagnostic Accuracy
- Hip Ultrasound Screening
Background:
- Developmental dysplasia of the hip (DDH) is a common condition in children.
- Early diagnosis is crucial for effective treatment and preventing long-term complications.
- Lack of standardized screening can lead to delayed or missed diagnoses.
Purpose of the Study:
- To identify risk factors for misdiagnosis of DDH in children not undergoing hip ultrasound screening.
- To analyze trends in misdiagnosis rates over time.
- To determine the impact of physician experience and department on diagnostic accuracy.
Main Methods:
- Retrospective review of 351 children with DDH diagnosed between 2010 and 2021.
- Comparison of patients diagnosed at first visit versus those misdiagnosed.
- Logistic regression analysis to identify significant risk factors for misdiagnosis.
Main Results:
- 27.1% of children with DDH were misdiagnosed at their initial visit.
- No significant trend in annual misdiagnosis rates observed from 2010-2020.
- Misdiagnosis was associated with initial consultation in pediatrics or general orthopedics, and with junior physicians.
Conclusions:
- Children with DDH lacking ultrasound screening are at high risk for initial misdiagnosis.
- Physician specialty and seniority are significant independent risk factors for misdiagnosis.
- Improved diagnostic protocols and training are needed to reduce misdiagnosis rates.
Objective:
To investigate risk factors of misdiagnosis at the first visit of children with developmental dysplasia of the hip (DDH) who did not participate in hip ultrasound screening.
Methods:
A retrospective review was conducted on children with DDH admitted to a tertiary hospital in northwestern China between January 2010 and June 2021. We divided the patients into the diagnosis and misdiagnosis groups according to whether they were diagnosed at the first visit. The basic information, treatment process and medical information of the children were investigated. We made a line chart of the annual misdiagnosis rate to observe the trend in the annual misdiagnosis rate. Univariate and multivariate logistic regression analyses were used to identify significant risk factors for missed diagnosis.
Results:
A total of 351 patients met the inclusion criteria, including 256 (72.9%) patients in the diagnosis group and 95 (27.1%) patients in the misdiagnosis group. The line chart of the annual rate of misdiagnoses among children with DDH from 2010 to 2020 showed no significant change trend. Multiple logistic regression analysis showed that the paediatrics department (v the paediatric orthopaedics department: OR 0.21, p<0.001), the general orthopaedics department (v the paediatric orthopaedics department: OR 0.39, p=0.006) and the senior physician (v the junior physician: OR 2.47, p=0.006) on the misdiagnosis at the first visit of children were statistically significant.
Conclusion:
Children with DDH without hip ultrasound screening are prone to be misdiagnosed at their first visit. The annual misdiagnosis rate has not been significantly reduced in recent years. The department and title of the physician are independent risk factors for misdiagnosis.
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