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[Results of hip ultrasonographic screening in Austria]
1Abteilung für Orthopädie des Kindes- und Jugendalters, Orthopädisches Spital Wien-Speising.
Insights
Austrian hip screening using ultrasound (sonography) effectively detects hip dysplasia in newborns. This reduces surgical treatment rates and associated long-term costs, proving its value in early detection.
Area of Science:
- Pediatrics
- Orthopedic Surgery
- Diagnostic Imaging
Background:
- Neonatal hip screening via sonography remains a debated topic.
- The Austrian national hip ultrasound screening program has been in place since 1985.
Purpose of the Study:
- To evaluate the effectiveness of the Austrian hip sonography screening program.
- To analyze changes in treatment rates and outcomes for developmental dysplasia of the hip (DDH).
Main Methods:
- Analysis of data from Austrian public health insurance and ICD hospitalization records since 1985.
- Tracking sonographically pathological hips and treatment rates before and after screening implementation.
Main Results:
- The rate of sonographically pathological hips was 6.57% in 1994.
- The treatment rate for DDH decreased from 13.16% in 1985 to significantly lower levels.
- The rate of open hip reduction dropped to 0.24 per 1000 newborns.
Conclusions:
- Hip sonography is effective in identifying hip joint instability and dysplasia.
- Screening between 4-6 weeks of age is optimal, potentially reducing costs with a single scan.
- Early detection and treatment via sonography can prevent long-term disability and reduce healthcare costs associated with DDH.
Abstract:
The role of hip sonography in neonatal hip screening is still a controversial matter. This paper reports the results of the Austrian ultrasound hip screening program, in which all Austrian babies undergo hip sonography twice: at the birth clinic during the 1st week of life and at an age of 12-16 weeks. Data from all public health insurance companies since 1985 and all ICD data about children hospitalized because of CDH in Austria were collected and analyzed. The rate of sonographically pathological hips was 6.57% (1994). The treatment rate before introduction of hip sonography was 13.16% (1985). The rate of open reduction went down to 0.24 per 1000 newborns, including a high number of unscreened children born abroad and also children with teratological dislocation of the hip. Hip sonography screening proved to be effective in detecting true instability of the hip joint as well as dysplasia. The optimal time for sonographic screening does not seem to be immediately after birth when only "high risk" hips (clinical instability, positive family history, breech delivery) should undergo hip sonography, but at an age between 4 and 6 weeks when the hip has already shown its true nature. Since one sonographic scan appears to be sufficient for screening, a further reduction of costs could be accomplished. Disability owing to DDH can be avoided in a number of cases, and costs for conservative and surgical treatment as well as for later endoprostheses and early retirement can be economized.