Self-reported knowledge of national guidelines for clinical screening for hip dysplasia: a web-based survey of midwives and GPs in Denmark

Abstract

BackgroundThe positive predictive value of clinical hip examinations performed by generalist health professionals in screening for developmental dysplasia of the hip (DDH) is low.AimTo assess the self-reported recognition of nationally recommended clinical hip examinations in the screening programme for DDH in Denmark among midwives, general practitioners (GPs), and GPs in training.Design & settingA web based open survey study among Danish midwives, GPs and GPs in trainingMethodRespondents were asked to identify which of six written statements of clinical hip examinations were featured in the national Danish guidelines on DDH screening. Three statements were the official statements of the Ortolani, Galeazzi, and hip abduction examinations from the national guidelines and three statements were false and constructed by the author group. Participants were asked to select up to six statements.ResultsA total of 178 (58 GPs, 97 midwives and 23 GPs in training) responses were included.Eighty-nine per cent of responders correctly identified the Ortolani manoeuvre and 92% correctly identified one of the constructed descriptions as being false. The remaining four descriptions had significantly lower correct answer percentages ranging from 41% to 58% with significantly lower correct answer percentages of midwives for three out of all six descriptions when compared to GPs.ConclusionWe conclude that the recognition of two out of three recommended clinical hip examinations in the Danish screening program for DDH is overall low among current screeners. Efforts should be made to heighten the knowledge level by further education of screeners.

Pubo-Femoral Distances Measured Reliably by Midwives in Hip Dysplasia Ultrasound

“…Since the Cochrane review was published, evidence increasingly points towards limitations in the selective screening approach, as 85% of patients treated for DDH do not fulfill the criteria for selective ultrasound screening [ 6 ]. Further, primary screeners have insufficient knowledge of the clinical examinations and risk factors which constitute the foundation of the selective screening approach [ 7 , 8 , 9 ]. These findings might explain why 26 years of selective ultrasound screening in the UK has failed to reduce the rate of late DDH diagnoses.…”

The Ortolani test has a high positive predictive value in clinical hip screening for developmental dysplasia of the hip

“…However, also other factors might have played a role. A survey of primary screeners in Denmark revealed that the Ortolani manoeuvre was the only widely known clinical hip examination 20 . The screeners did not recognise correct statements from false statements produced by the investigators regarding the Danish guidelines for screening.…”

“…A survey of primary screeners in Denmark revealed that the Ortolani manoeuvre was the only widely known clinical hip examination. 20 The screeners did not recognise correct statements from false statements produced by the investigators regarding the Danish guidelines for screening. It is possible, that some of the Barlow tests were mis-interpreted as positive in the present study.…”

Ultrasonographic Assessment of the Proximal Femoral Ossification Center in Children Under 1 Year

“…-в Германии в качестве метода общего обследования всех новорожденных [8,9]. В США, Великобритании, скандинавских странах ультрасонография проводится селективно новорожденным группы риска [10,11,12]. В настоящее время существует несколько методик УЗИ ТБС: Графа, Харке, Сузуки, Тержесена и т.д.…”