Effectiveness of ultrasound screening for developmental dysplasia of the hip

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 90; no. 1; pp. F25 - F30
• Main Authors: Roovers, E A, Boere-Boonekamp, M M, Castelein, R M, Zielhuis, G A, Kerkhoff, T H
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.01.2005; BMJ Publishing Group LTD; BMJ Group
• Subjects: Age; Age Factors; CHC; child health care; Children & youth; Childrens health; DDH; developmental dysplasia of the hip; Diagnostic tests; dysplasia of the hip; Health care; Hip Dislocation, Congenital - diagnosis; Hip Dislocation, Congenital - diagnostic imaging; Hip Dislocation, Congenital - therapy; Humans; Infant; Mass Screening - methods; Original; Physical Examination; Population; Prospective Studies; Referral and Consultation - statistics & numerical data; Risk factors; screening; Sensitivity and Specificity; Studies; Surveillance; Ultrasonic imaging; Ultrasonography; Netherlands
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/adc.2003.029496

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.