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A national survey of screening for congenital dislocation of the hip
1Department of Epidemiology and Biostatistics, Institute of Child Health, London.
Insights
Ultrasound hip screening for congenital dislocation of the hip (CDH) is increasingly used in the UK for secondary assessment. However, practices vary widely, highlighting the need for research to establish effective screening methods.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Public Health
Background:
- Congenital dislocation of the hip (CDH) requires early detection and management.
- Screening practices for CDH have evolved with advancements in imaging technology.
- Variability in current screening and management protocols necessitates evaluation.
Purpose of the Study:
- To assess current screening and management strategies for CDH in the UK and Irish Republic.
- To determine the prevalence and application of hip ultrasound in neonatal care.
- To identify gaps in current practices and research needs for CDH.
Main Methods:
- A national postal questionnaire survey was distributed to pediatricians in maternity units across the UK and Irish Republic.
- The survey focused on routine neonatal care providers responsible for hip screening.
- Response rate was 92% (254 maternity units).
Main Results:
- By 1994, 69% of units had hip ultrasound access, a significant increase from 14% in 1984.
- Ultrasound was primarily used for secondary screening (93%) in high-risk infants or those with clinical instability, not universal primary screening.
- Clinical screening training was limited (37% used hip simulator models), and treatment protocols for hip instability showed wide variation.
Conclusions:
- Hip ultrasound is increasingly utilized in the UK for secondary screening of CDH.
- Current national recommendations for CDH screening and management are inconsistently applied.
- Significant variation in screening and management underscores a lack of evidence-based guidelines and the need to establish effective screening protocols.
Objective:
To identify current screening and management practices for congenital dislocation of the hip (CDH), and determine the extent to which ultrasound imaging of the hips is practised throughout the United Kingdom and the Irish Republic.
Methods:
Postal questionnaire to paediatricians responsible for the routine neonatal care of infants in all maternity units in the UK and the Irish Republic.
Results:
Questionnaires were returned for 254 maternity units (92% response rate). By 1994, 69% of maternity units had access to ultrasound imaging of the hips, compared to 14% in 1984. Ultrasound imaging of the hip was not used for universal primary screening, but in 93% of units was undertaken for further assessment of infants with clinically detected hip instability or those identified as being at high risk of CDH, or both. Clinical screening of newborn infants was performed by junior paediatricians, but training with a 'Baby Hippy' hip simulator model was provided in only 37% of units. Treatment of clinically detected hip instability, initiated by an orthopaedic surgeon in 93% of units, varied widely in type and duration.
Conclusions:
Ultrasound imaging of the hip is increasingly used in the UK for secondary, rather than primary, screening. Current recommendations are implemented to a variable extent nationally, and the existing wide variation in screening and management for CDH reflects a lack of research evidence to support current screening practices. The effectiveness of screening for CDH needs to be established.
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