Quality improvement report: Clinical screening for developmental dysplasia of the hip in Northern Ireland

Maxwell, Sarah; Ruiz, Ana; Lappin, Kieran; Cosgrove, A.P.

doi:10.1136/bmj.324.7344.1031

Cited by 31 publications

(33 citation statements)

References 17 publications

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“…Several observational studies examined the impact of age at the time of intervention. 25,81,95,[110][111][112][113] In 1 small study that included children initiating therapy for DDH from birth through 4 months of age, duration of treatment increased in a dose-response fashion as the age at initiation of treatment increased, holding the severity of DDH steady. 81 In a separate series of patients who underwent surgery for DDH (70% of whom had failed therapy with a Pavlik harness), those who were 6 to 9 months of age (18 patients) required no additional corrective surgeries, whereas 29% of the patients 10 to 11 months of age, 13% of patients 12 to 14 months of age, 26% of patients 15 to 18 months of age, and 30% of patients 19 to 24 months of age required additional surgical interventions.…”

Section: Biological Plausibilitymentioning

confidence: 99%

“…95,112 In a study that focused on late diagnosis of DDH, closed reduction failed in a similar proportion of cases in children aged 0 to 3 months as those 3 to 6 months but failed significantly more frequently after 6 months of age (no upper age limit was identified, potentially biasing these conclusions). 113 Finally, a study of 55 children who underwent operative procedures for DDH between 1988 and 1998 found that procedures were less invasive in children who were Ͻ6 months. All children Ͼ12 months who underwent a procedure for DDH required an osteotomy, the most invasive procedure.…”

Section: Biological Plausibilitymentioning

confidence: 99%

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Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

Shipman¹,

et al. 2006

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Section: Biological Plausibilitymentioning

confidence: 99%

Section: Biological Plausibilitymentioning

confidence: 99%

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

Shipman¹,

et al. 2006

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“…Maxwell mentions that the incidence based on clinical examination amounts to 1.66% (17), while Alečković, Brecelj and Šoć state, based on the research in Donja Zeta, that it amounts to as much as 40% (20). Barlow mentions a very low DDH incidence that is based on clinical examination.…”

Section: Discussionmentioning

confidence: 99%

“…There has been a rise in this percentage in other countries too. In France, it amounted to 10% in 1981 and to 20% in 2004 (17,19).…”

Section: Discussionmentioning

confidence: 99%

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Value of the First Examination for Developmental Dysplasia of the Hip - Our Experiences

Grubor¹,

Grubor²,

Domuzin³

et al. 2012

Acta Facultatis Medicae Naissensis

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Developmental dysplasia of the hip (DDH) means a distinct dislocation (lateralisation and cranialisation) of the femoral head from the poorly developed (hypoplastic and steeper) acetabulum.The aim of the paper was to establish, in a retrospective and prospective study conducted in the period between January 1, 2006 and December 31, 2010, the total number and characteristics of instances of DDH in the first clinical and ultrasound examinations in newborns examined at the Traumatology Clinic of the Clinical Centre in Banja Luka.Six thousand one hundred thirty-two children were examined and 99 were treated. The percentage of girls among the treated children was considerably higher (96%). The ultrasound examination was performed first and was followed by the clinical examination. The ultrasound examination of all babies was performed with an electronic 5-12-MHz probe, using the standard Graf's method.7.8% of the cases, mostly primiparae, had a positive family history of DDH. The incidence diagnosed clinically amounted to 8.87%, and the incidence diagnosed by ultrasound to 1.61%. The first clinical examination diagnosed a limited abduction of the right hip in 12.1% of the newborns, while limited abduction of the left hip was present in 96.0%. Ortolani's sign in the right hip was positive in 3.0% and in 33.3% patients it was positive in the left hip. 3.0% of the newborns had a positive Palmen sign in the right hip in the first examination, and 42.4% in the left. 3% of the patients had asymmetric skin creases on the right upper leg, while 87.9% of the patients had them on the left upper leg. 46.5% of the patients had crepitations in their right hip, while 83.8% had crepitations in the left hip. 2% of the patients had a lax right hip, while 3% had a lax left hip. The results obtained from the ossified acetabulum of the right hip in the examined sample were as follows: good in 91.9%, satisfactory in 5.1%, insufficient (deficient) in 2.0%, and bad in 1.0% of the cases. The results from the left ossified acetabulum were as follows: good in 3.0%, satisfactory in 44.4%, insufficient (deficient) in 45.5 %, bad in 7.1% of the cases. The bony protrusion -acetabular labrum on the right hip was angular in 90.9%, obtuse (fused) in 1.0%, round in 7.1%, round to flat and flat in 1.0% of the cases. The bony protrusion -acetabular labrum on the left hip was angular in 2.0 %, obtuse (fused) in 2.0%, round in 81.8%, round to flat and flat in 14.1% of the cases.It is important to commence with diagnosing and treating DDH as early as possible by applying atraumatic aids and procedures while all structures are elastic, reducible and adaptable.The clinical examination is unreliable in terms of diagnosis of DDH, but it is mandatory as a part of the full physical examination of a newborn baby.

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Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy

et al. 2022

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ImportanceUniversal ultrasonographic screening for developmental dysplasia of the hip (DDH) has gained increasing popularity despite the lack of benefit in terms of reducing the rates of late-detected cases (age ≥12 weeks) in randomized clinical trials.ObjectiveTo report the reported incidence of DDH in the English scientific literature and compare rates of late-detected cases in settings with different DDH screening strategies.Data SourcesPubMed, Scopus, and Web of Science databases were searched on November 25 and 27, 2021. No time filters were used in the search.Study SelectionAll observational studies reporting the incidence of early-detected or late-detected (age ≥12 weeks) DDH were included. Non-English reports were excluded if the abstract did not include enough information to be included for analysis.Data Extraction and SynthesisThe number of newborns screened and the detection rates were extracted. Meta-analysis calculated the pooled incidence of DDH per 1000 newborns with 95% CIs using a random- or fixed-effects model. This study is reported according to the PRISMA and MOOSE guidelines.Main Outcomes and MeasuresThe main outcome measures were early detection, early treatment, late detection, and operative treatment incidences.ResultsA total of 1899 studies were identified, 203 full texts were assessed, and 76 studies with 16 901 079 infants were included in final analyses. The early detection rate was 8.4 (95% CI, 4.8-14.8) infants with DDH per 1000 newborns with clinical screening, 4.4 (95% CI, 2.4-8.0) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 23.0 (95% CI, 15.7-33.4) infants with DDH per 1000 newborns with universal ultrasonographic screening. Rates for nonoperative treatment were 5.5 (95% CI, 2.1-14) treatments per 1000 newborns with clinical screening, 3.1 (95% CI, 2.0-4.8) treatments per 1000 newborns with selective ultrasonographic screening, and 9.8 (95% CI, 6.7-14.4) treatments per 1000 newborns with universal ultrasonographic screening. The incidence of late-detected DDH was 0.5 (95% CI, 0.2-1.5) infants with DDH per 1000 newborns with clinical screening, 0.6 (95% CI, 0.3-1.3) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 0.2 (95% CI, 0.0-0.8) infants with DDH per 1000 newborns with universal ultrasonographic screening. The corresponding incidences of operative treatment were 0.2 (95% CI, 0.0-0.9) operations per 1000 newborns with clinical screening, 0.5 (95% CI, 0.4-0.7) operations per 1000 newborns with selective ultrasonographic screening, and 0.4 (95% CI, 0.2-0.7) operations per 1000 newborns with universal ultrasonographic screening.Conclusions and RelevanceThis meta-analysis found that early detection rates and nonoperative treatments were higher with universal screening. The late detection and operative treatment rates with universal screening were similar to those among selectively and clinically screened newborns. Based on these results, universal screening may cause initial overtreatment without reducing the rates of late detection and operative treatment.

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Quality improvement report: Clinical screening for developmental dysplasia of the hip in Northern Ireland

Abstract: Improvements to screening processes can reduce late incidence of developmental dysplasia of the hip. Further steps to improve detection in children with known risk factors and rate of detection at first referral could reduce late presentation further.

Cited by 31 publications

References 17 publications

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

Value of the First Examination for Developmental Dysplasia of the Hip - Our Experiences

Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy

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