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Radiological assessment of hip disease in children with cerebral palsy: development of a core measurement set
Prince J S Joseph1, Mohammed Khattak1,2, Sundas T Masudi3
1University of Liverpool, Liverpool, UK.
Insights
A core measurement set for hip surveillance in children with cerebral palsy (CP) was developed. This standardized approach aims to improve consistency in radiological outcomes for better clinical care and research.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Medical Imaging
Background:
- Hip disease is a common complication in children with cerebral palsy (CP), significantly impacting their quality of life and functional abilities.
- Current radiological surveillance programs for hip disease in CP lack standardized outcome measures, hindering comparative analysis and consistent treatment strategies.
Purpose of the Study:
- To identify and establish a core measurement set (CMS) for radiological assessment of hip disease in children with CP.
- To promote uniformity in clinical practice, research studies, and surveillance programs for improved patient outcomes.
Main Methods:
- A systematic review identified radiological measurements used in studies of hip outcomes in children with CP.
- A two-round Delphi study involving orthopedic surgeons and physiotherapists was conducted to rate the importance of identified measurements.
- A consensus meeting finalized the core measurement set.
Main Results:
- A systematic review identified 14 distinct radiological measurements, with Reimer's migration percentage being most common.
- The Delphi process and consensus meeting resulted in the selection of two key measurements: Reimer's migration percentage and femoral head-shaft angle.
- These two measurements form the core measurement set for hip surveillance in children with CP.
Conclusions:
- The developed CMS provides a standardized minimum set of measurements for hip surveillance in children with CP.
- This standardization is expected to enhance consistency across surveillance programs and facilitate the development of automated analysis tools, such as AI systems.
- Adoption of this core set will enable more reliable comparisons between studies and support future meta-analyses, ultimately improving the management of hip disease in this population.
Aims:
Hip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes.
Methods:
A systematic review identified a list of measurements previously used in studies reporting radiological hip outcomes in children with CP. These measurements informed a two-round Delphi study, conducted among orthopaedic surgeons and specialist physiotherapists. Participants rated each measurement on a nine-point Likert scale ('not important' to 'critically important'). A consensus meeting was held to finalize the CMS.
Results:
Overall, 14 distinct measurements were identified in the systematic review, with Reimer's migration percentage being the most frequently reported. These measurements were presented over the two rounds of the Delphi process, along with two additional measurements that were suggested by participants. Ultimately, two measurements, Reimer's migration percentage and femoral head-shaft angle, were included in the CMS.
Conclusion:
This use of a minimum standardized set of measurements has the potential to encourage uniformity across hip surveillance programmes, and may streamline the development of tools, such as artificial intelligence systems to automate the analysis in surveillance programmes. This core set should be the minimum requirement in clinical studies, allowing clinicians to add to this as needed, which will facilitate comparisons to be drawn between studies and future meta-analyses.
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