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Ultrasound for hip dysplasia - disparities between community and tertiary paediatric services
Ye Zhu1, Melody Feng2, Ishith Seth2
1Royal Melbourne Hospital, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, Australia.
Insights
Ultrasound reporting for developmental dysplasia of the hip (DDH) shows moderate agreement between community and tertiary centers. Standardized reporting is needed to ensure accurate diagnosis and treatment for infants.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Ultrasound
- Hip Dysplasia Diagnosis
Background:
- Developmental dysplasia of the hip (DDH) is a common pediatric condition requiring accurate ultrasound diagnosis.
- Variations in ultrasound reporting between different healthcare settings can impact diagnostic accuracy and patient management.
Purpose of the Study:
- To compare ultrasound reporting practices for DDH between community centers and a high-volume pediatric tertiary center.
- To identify discrepancies in reporting parameters and their potential impact on diagnosis.
Main Methods:
- A retrospective review of 100 infants under 6 months from a pediatric hip registry.
- Ultrasound reports from both community and tertiary centers within a 2-week interval were analyzed.
- Key parameters like alpha angle, femoral head coverage, and beta angle were assessed for reporting consistency.
Main Results:
- While femoral head coverage was reported consistently (around 94%), alpha angles were reported more frequently in community centers (84.5%) than tertiary centers (78.5%).
- Beta angle reporting showed a significant disparity, appearing in 45% of community reports versus only 2% of tertiary reports.
- Moderate agreement (concordance correlation coefficient Rho ≈ 0.60, Cohen's Kappa ≈ 0.50) was found for alpha angle and femoral head coverage between the two settings, indicating significant variation.
Conclusions:
- Community ultrasound reports for DDH may not fully reflect the hip's condition, necessitating caution in clinical decision-making.
- Lack of standardized reporting protocols in community settings poses challenges for timely treatment initiation and appropriate referrals.
- Discrepancies in ultrasound interpretation could lead to misclassification of hips, potentially resulting in over-diagnosis or under-diagnosis of DDH.
Objective:
Explore the differences in ultrasound reporting between community ultrasound centres and a high-volume paediatric tertiary centre in diagnosing developmental dysplasia of the hip (DDH).
Participants:
One hundred infants less than 6 months of age from a paediatric hip registry, who underwent ultrasounds in both community and tertiary centres within a 2-week interval.
Results:
One percent of a 200-hip sample reported scan quality. Alpha angles were reported in 84.5% (n = 169) of community reports and 78.5% (n = 157) of tertiary centre reports. Femoral head coverage was reported similarly in both environments at 94.5% in community and 93.5% in tertiary. Beta angle appeared in 45% (n = 90) and 2% (n = 4), respectively. Bland Altman plots revealed that there existed variation in ultrasound interpretation especially in more dysplastic hips. The concordance correlation coefficient showed only moderate agreement (Rho = 0.60 for alpha angles, Rho = 0.61 for femoral head coverage), and interrater reliability on hip classification reached moderate agreement (Cohen's Kappa = 0.57 for alpha angle, and 0.45 for femoral coverage) between community and tertiary hospital reports.
Conclusions:
Reliance on the community-acquired ultrasound report as a true reflection of the state of a hip is not completely justified. The lack of standardized reporting poses challenges for community clinicians in starting treatment or making appropriate referrals. Only a moderate agreement has been observed between the community and tertiary scans. Consequently, over 25% of hips classified as abnormal are potentially normal, and more than 15% dysplastic hips could be undetected.
