Effectiveness of ultrasound screening for developmental dysplasia of the hip

Abstract

Objective: To determine the effectiveness of ultrasound screening for developmental dysplasia of the hip (DDH) after the neonatal period. Design: Prospective cohort study. Setting: Child health care centres. Participants: Infants attending the child health care centres. Interventions: The intervention group (n = 5170) was screened by ultrasound at 1, 2, and 3 months of age. The control group (n = 2066) was screened by routine physical examination as part of the programme for child health surveillance at the child health care centres (CHC screening). For evaluation of the screening, the children in both the intervention and control group received an ultrasound examination after 6 months of age to detect any abnormality that might have been missed by the screening. Results: The sensitivity of the ultrasound screening was 88.5%, and the referral rate 7.6%. As a result of the ultrasound screening, 4.6% of the children were treated. The sensitivity of the CHC screening was 76.4%, with a referral rate of 19.2%. The treatment rate was 2.7%. Of the treated children in the ultrasound screening group, 67% were referred before the age of 13 weeks, whereas in the CHC screening group only 29% were referred before this age. Conclusions: This study shows that ultrasound screening detects more children with DDH than CHC screening and that more of them are detected at an earlier age. To accomplish this, even fewer children have to be referred. However, even general ultrasound screening seems not to eradicate late cases of DDH. The higher treatment rate in the population screened by ultrasound may be a result of overtreatment.

Hip Ultrasonography in the Diagnosis of Developmental Dysplasia of the Hip: Bakırköy Experience

“…Yenidoğanda fizik muayene, GKD'nin saptanmasında birincil tanısal yaklaşım olmasına rağmen tek başına klinik muayenenin GKD tanısında duyarlılığı sınırlıdır (26). Fizik muayene ile birlikte kullanıldığında YKU, GKD tanısı için oldukça yardımcı bir yöntemdir.…”

Rechtstreeks verwijzen door de jeugdarts bij verdenking op heupdysplasie: het perspectief van ouders

“…Hieruit bleek dat echografische screening van kinderen op de leeftijd van drie maanden leidt tot minder gemiste gevallen en relatief weinig verwijzingen. 6 Behalve klinische uitkomstmaten van screening op heupdysplasie zijn ook minder objectieve maten, zoals tevredenheid van de ouders met de screening, van belang. 7 De tevredenheid van patiënten is een belangrijke determinant voor de kwaliteit van de geleverde zorg [8][9] en heeft invloed op het gedrag van patiënten, zoals het naleven van een aanbevolen behandeling.…”

Problemas prácticos y éticos de la prevención secundaria: A propósito de dos ejemplos en pediatría

“…Así, se demuestra reiteradamente que dicho cribado ecográfico universal en los tres primeros meses de vida incrementa los casos diagnosticados y tratados sin que mejore el resultado global, lo que sugiere sobre-diagnóstico y sobre-tratamiento 17,18 .…”

“…En un ejemplo reciente se seleccionó para el cribado mediante ecografía de caderas a niños con factores de riesgo (historia familiar, presentación podálica y/o chasquido persistente) y cadera normal en el examen clínico a los dos días del nacimiento 17,18 . Con estos dos criterios se seleccionó al 10% del total de los recién nacidos.…”