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Globally inconsistent: Countries with top health indices erratic developmental hip dysplasia screening protocols
Natalie L Zusman1, Pablo G Castañeda2, Rachel Y Goldstein1
1Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
International screening for developmental hip dysplasia lacks standardization. This study found significant variations in screening methods and inconsistent reporting of incidence rates among top global health countries.
Area of Science:
- Pediatrics
- Musculoskeletal Health
- Global Health Policy
Background:
- Developmental hip dysplasia (DDH) is a common pediatric condition.
- Current international screening practices for DDH are not standardized.
- There is a need to understand global approaches to DDH screening and epidemiology.
Purpose of the Study:
- To characterize DDH screening protocols in countries with high global health indices.
- To explore variations in reported epidemiologic rates of DDH.
- To identify inconsistencies in international DDH screening and data collection.
Main Methods:
- A scoping review of DDH screening protocols was conducted.
- Countries ranked in the top 25 of the Bloomberg Global Health Index were analyzed.
- Data on screening methods and incidence rates were collected and analyzed.
Main Results:
- Eighty percent of analyzed countries had searchable DDH screening programs.
- Clinical screening with selective universal screening was most common.
- Four countries utilized universal ultrasound screening; no countries used radiographic screening.
- Incidence rate reporting varied significantly in definition and cohort.
- Five countries lacked searchable screening programs.
Conclusions:
- Significant international inconsistencies exist in DDH screening protocols and epidemiologic data collection.
- Variations in screening practices persist despite calls for uniformity.
- Increased consistency and transparency in DDH management are recommended.
Purpose:
Developmental hip dysplasia is a prevalent pediatric musculoskeletal condition that lacks international standardized screening. We sought to characterize developmental hip dysplasia screening practices in countries with the top global health indices. We also explored diverse definitions in reported epidemiologic rates of this condition.
Methods:
We performed a scoping review of developmental hip dysplasia screening protocols utilizing countries ranked in the top 25 of the Bloomberg Global Health Index using a protocolized search strategy, progressing from academic to layperson sources. A reference was eligible for inclusion if it mentioned the countries' screening program and developmental hip dysplasia was the pathology of concern. Incidence rates, when present, were also recorded. The United States Census Bureau's International Database tool provided countries' populations. We compiled the data and performed descriptive statistics and appropriate validation methods.
Results:
Twenty countries (80%) had searchable screening programs. Clinical screening with selective universal screening was the most commonly observed (n = 16). Four countries had universal ultrasound screening: Switzerland, Austria, Germany, and Slovenia. Five countries did not have searchable programs. No countries employed radiographic screening. Incidence rates were expressly stated in the literature for nine countries; however, the cohort of interest varied from developmental hip dysplasia versus severity of developmental hip dysplasia versus miscellaneous (e.g. requiring hospitalization).
Conclusion:
The findings of this investigation highlight international inconsistencies regarding developmental hip dysplasia screening and epidemiologic data. Screening variations exist despite consensus statements calling for uniformity. We agree with prior literature advocating for increasing consistency in developmental hip dysplasia management or, at a minimum, increasing transparency regarding how we manage these young patients.
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