1
|
Taylor MA, Maclean JG. Anterior hip ultrasound: A useful technique in developmental dysplasia of the hips. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2021; 29:179-186. [PMID: 34567230 DOI: 10.1177/1742271x20967692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022]
Abstract
Introduction: Infant developmental dysplasia of the hips arises when there is an interruption to normal joint development, usually present at birth but may be a later development. It has a wide spectrum of severity with potentially disastrous long-term complications if left untreated. Incidence is highly variable, often being attributed to differences of opinion in definition and diagnosis; however, there is consensus that ultrasound be used in screening and management. Topic Description: The anterior hip ultrasound technique is underutilised but is of value due to the additional confidence it provides regarding joint stability. Discussion: The ability to relate the acquired ultrasound image to hip anatomy and a technical appreciation of the technique are crucial to successful use. The method is described and its use within previous literature briefly outlined. Using pictorial ultrasound imaging examples to demonstrate the technique, we aim to highlight the anterior approach as a useful addition to ultrasound assessment of infant developmental dysplasia of the hips. Conclusion: Knowledge and understanding of different techniques is essential for practitioners involved in the diagnosis and management of this multifaceted and vigorously debated condition.
Collapse
|
2
|
Li H, Shu L, Yu J, Xian Z, Duan H, Shu Q, Ye J. Using Z-score to optimize population-specific DDH screening: a retrospective study in Hangzhou, China. BMC Musculoskelet Disord 2021; 22:344. [PMID: 33845817 PMCID: PMC8042719 DOI: 10.1186/s12891-021-04216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND DDH (Developmental Dysplasia of the Hip) screening can potentially avert many morbidities and reduce costs. The debate about universal vs. selective DDH ultrasonography screening in different countries revolves to a large extent around effectiveness, cost, and the possibility of overdiagnosis and overtreatment. In this study, we proposed and evaluated a Z-score enhanced Graf method to optimize population-specific DDH screening. METHODS A total of 39,710 history ultrasonography hip examinations were collected to establish a sex, side specific and age-based Z-scores model using the local regression method. The correlation between Z-scores and classic Graf types was analyzed. Four thousand two hundred twenty-nine cases with follow-up ultrasonographic examinations and 5284 cases with follow-up X-ray examinations were used to evaluate the false positive rate of the first examination based on the subsequent examinations. The results using classic Graf types and the Z-score enhanced types were compared. RESULTS The Z-score enhanced Graf types were highly correlated with the classic Graf's classification (R = 0.67, p < 0.001). Using the Z-scores ≥2 as a threshold could reduce by 86.56 and 80.44% the false positives in the left and right hips based on the follow-up ultrasonographic examinations, and reduce by 78.99% false-positive cases based on the follow-up X-ray examinations, respectively. CONCLUSIONS Using an age, sex and side specific Z-scores enhanced Graf's method can better control the false positive rate in DDH screening among different populations.
Collapse
Affiliation(s)
- Haomin Li
- Clinical Data Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China.
| | - Liqi Shu
- Rhode Island Hospital, Brown University, Providence, USA
| | - Jin Yu
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China
| | - Zeng Xian
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- Clinical Data Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China
| | - Jingjing Ye
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China.
| |
Collapse
|
3
|
Karakus O, Karaman O, Sari AS, Orak MM, Muratli HH. Is it difficult to obtain inter-observer agreement in the measurement of the beta angle in ultrasound evaluation of the paediatric hip? J Orthop Surg Res 2019; 14:221. [PMID: 31315640 PMCID: PMC6637646 DOI: 10.1186/s13018-019-1263-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction The aim of this study was to determine the differences and consistencies in the morphological and angular interpretations of standard USG images. Therefore, it was aimed to show the correlations of orthopaedic doctors with different periods of experience in hip ultrasound measurements taken with the Graf method. Materials and methods The study included 210 infants randomly selected from those who presented at our hospital for DDH screening. A total of 6 ultrasound images were taken for each hip. These images were evaluated by two paediatric orthopaedic professors, two orthopaedic specialists and two orthopaedic residents. The correlations of these measurements between all the doctors were evaluated statistically. Results In beta angle evaluation, agreement between all the evaluators was at the level of 0.054. No agreement was seen between the two residents or between the two specialists (p = 0.003, p = 0.998, p = 0.998, respectively). Agreement between the two professors was determined at the level of 0.508 (p < 0.001). Agreement was determined at the level of 0.066 between the specialists and the residents. No agreement was observed between the specialists and the professors or between the professors and the residents (p = 0.014, p = 0.098, p = 0.737, respectively). Conclusions It can be concluded that greater emphasis on the beta angle, the cartilage labrum, and more detailed explanations of this subject in the resident training program will achieve standardisation on this subject, and this is in direct proportion to clinical experience. Level of evidence IV
Collapse
Affiliation(s)
- Ozgun Karakus
- Fatih Sultan Mehmet Training and Research Hospital, Omer Halisdemir University Hospital, Petrolıs st. Sümer bloc no: A-16 Kartal, İstanbul, Turkey.
| | - Ozgur Karaman
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | | | - Mehmet Mufit Orak
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Hasan Hilmi Muratli
- Fatih Sultan Mehmet Training and Research Hospital, Marmara University, Istanbul, Turkey
| |
Collapse
|
4
|
Shirai Y, Wakabayashi K, Wada I, Goto H, Ueki Y, Tsuchiya A, Tsuboi Y, Ha M, Otsuka T. Reproducibility of acquiring ultrasonographic infant hip images by the Graf method after an infant hip ultrasound training course. J Med Ultrason (2001) 2018. [DOI: 10.1007/s10396-018-0876-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
5
|
Olsen SF, Blom HC, Rosendahl K. Introducing universal ultrasound screening for developmental dysplasia of the hip doubled the treatment rate. Acta Paediatr 2018; 107:255-261. [PMID: 28871598 DOI: 10.1111/apa.14057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/16/2017] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Abstract
AIM There is no evidence on the effect of universal ultrasound screening on developmental dysplasia of the hip. We examined the impact of adding an ultrasound examination to a one examiner clinical screening strategy on treatment, follow-up rates and the number of cases detected late in a low-prevalence population. METHODS All eligible babies born at Kongsberg Hospital, Norway, from 1998 to 2006 (n = 4245) underwent both clinical and ultrasound hip examinations within three days of life. Indications for immediate treatment were positive Barlow or Ortolani manoeuvres and, or, sonographic dysplasia. Sonographic immature hips were followed until normalisation. Treatment rates and rates from the 1989 to 1997 prestudy period (n = 3594), including late diagnoses, were collected from hospital records. RESULTS Treatment was initiated in 90 (2.1%) infants (74 girls), 63 (70%) from birth, compared to 33 (0.9%) during the prestudy period. The follow-up rate did not change (11%). There were two (0.5/1000) and four (1.0/1000) cases detected late, respectively. No one underwent surgery during the first year of life and no avascular necrosis was seen. CONCLUSION Adding universal ultrasound to clinical screening performed by the same, experienced paediatrician doubled the treatment rate, without influencing the already low numbers of late cases.
Collapse
Affiliation(s)
- Stine F. Olsen
- Department of Radiology; Vestre Viken Hospital Trust; Drammen Norway
| | - Hans C. Blom
- Department of Orthopedic surgery; Vestre Viken Hospital Trust; Kongsberg Norway
| | - Karen Rosendahl
- Department of Clinical Medicine, K1; University of Bergen; Bergen Norway
- Department of Radiology; Haukeland University Hospital; Bergen Norway
| |
Collapse
|
6
|
Justicia-Grande AJ, Pardo Seco J, Rivero Calle I, Martinón-Torres F. Clinical respiratory scales: which one should we use? Expert Rev Respir Med 2017; 11:925-943. [PMID: 28974118 DOI: 10.1080/17476348.2017.1387052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There are countless clinical respiratory scales for acute dyspnoea. Most healthcare professionals choose one based on previous personal experience or following local practice, unaware of the implications of their choice. The lack of critical comparisons between those different tools has been a widespread problem that only recently has begun to be addressed via score validation studies. Here we try to assess and compare the quality criteria of measurement properties of acute dyspnoea scores. Areas covered: A literature review was conducted by searching the PubMed database. Forty-five documents were deemed eligible as they reported the use or building of clinical scales, using at least two parameters, and applied these to an acute episode of respiratory dyspnoea. Our primary focus was the description of the validity, reliability and utility of 41 suitable scoring instruments. Differences in sample selection, study design, rater profiles and potential methodological shortcomings were also addressed. Expert commentary: All acute dyspnoea scores lack complete validation. In particular, the areas of measurement error and interpretability have not been addressed correctly by any of the tools reviewed. Frequent modification of pre-existing scores (in items composition and/or name), differences in study design and discrepancies in reviewed sources also hinder the search for an adequate tool.
Collapse
Affiliation(s)
- Antonio José Justicia-Grande
- a Translational Pediatrics and Infectious Diseases, Department of Pediatrics , Hospital Clínico Universitario de Santiago de Compostela , A Coruña , Spain.,b Healthcare Research Institute , Instituto de Investigación Sanitaria de Santiago, GENVIP group , Santiago de Compostela, A Coruña , Spain
| | - Jacobo Pardo Seco
- b Healthcare Research Institute , Instituto de Investigación Sanitaria de Santiago, GENVIP group , Santiago de Compostela, A Coruña , Spain
| | - Irene Rivero Calle
- a Translational Pediatrics and Infectious Diseases, Department of Pediatrics , Hospital Clínico Universitario de Santiago de Compostela , A Coruña , Spain.,b Healthcare Research Institute , Instituto de Investigación Sanitaria de Santiago, GENVIP group , Santiago de Compostela, A Coruña , Spain
| | - Federico Martinón-Torres
- a Translational Pediatrics and Infectious Diseases, Department of Pediatrics , Hospital Clínico Universitario de Santiago de Compostela , A Coruña , Spain.,b Healthcare Research Institute , Instituto de Investigación Sanitaria de Santiago, GENVIP group , Santiago de Compostela, A Coruña , Spain
| |
Collapse
|
7
|
Orak MM, Onay T, Çağırmaz T, Elibol C, Elibol FD, Centel T. The reliability of ultrasonography in developmental dysplasia of the hip: How reliable is it in different hands? Indian J Orthop 2015; 49:610-4. [PMID: 26806967 PMCID: PMC4705726 DOI: 10.4103/0019-5413.168753] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is the most common skeletal dysplasia. Two principal methods used in early diagnosis of DDH are clinical examination and ultrasonographic investigation. Dogruel et al. found a low specificity of clinical examination in patients with DDH. Additionally, Kamath et al. stated that ultrasonography performed by a radiologist in routine clinical practice is more reliable than physical examination performed by the average clinician. In clinical practice, the application and assessment of hip ultrasonography are completed by a single person. This assessment determines the followup of the patient. Thus, hip ultrasonography performed on the same person by different individuals under the same conditions will yield a more accurate assessment of the reliability of ultrasonographic assessment of DDH. Although inter-observer reliability was high in many previous studies of ultrasound image evaluation, reliability rates vary among studies of the application of ultrasonography. MATERIALS AND METHODS Inter-examiner reliability of hip ultrasonography was analyzed among four investigators who separately evaluated 100 hips (50 infants). The obtained bone structure angles α, cartilage structure angles β, and distribution of hip types were compared among the investigators. All infants were brought to the hospital for a healthy child followup examination, according to the country's health policy. Babies between 0 and 6 months were included in the study. Babies with any neuromuscular disorders, neural tube defects or any type of genetic anomalies were excluded from the study. The study was explained to the families of all infants and written informed consent was obtained. RESULTS There was a significant difference in the hip type determined by the investigators with respect to α and β angles (P < 0.01, P < 0.01, P = 0.002). The average alpha measurements of the first orthopedist, second orthopedist, first radiologist, and second radiologist were 67.38 ± 6.24, 65.60 ± 5.84, 65.44 ± 4.59, and 62.59 ± 4.50, respectively. The average beta measurements of the first orthopedist, second orthopedist, first radiologist, and second radiologist were 53.85 ± 8.86, 50.74 ± 7.80, 44.77 ± 6.30, and 44.39 ± 5.81, respectively. Agreement among the results obtained by the clinicians was investigated in dual comparisons. The relative agreement according to the alpha angle ranged from 3.6% to 44.5%, and the relative concordance according to the beta angle ranged from 0.9% to 45.3%. Agreement regarding hip typing was determined to range from 19.1% to 42.6%. CONCLUSION Sonographic evaluation of the hip appears to vary depending on the investigator.
Collapse
Affiliation(s)
- Mehmet Müfit Orak
- Department of Orthopedic and Traumatology, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey,Address for correspondence: Dr. Tolga Onay, Department of Orthopedic and Traumatology, Marmara University Education and Research Hospital, Istanbul, Turkey. E-mail:
| | - Tolga Onay
- Department of Orthopedic and Traumatology, Marmara University Education and Research Hospital, Istanbul, Turkey
| | - Talat Çağırmaz
- Department of Orthopedic and Traumatology, Biga State Hospital, Çanakkale, Istanbul, Turkey
| | - Cenk Elibol
- Department of Radiology, Muğla University Education and Research Hospital, Muğla, Istanbul, Turkey
| | - Funda Dinç Elibol
- Department of Radiology, Muğla University Education and Research Hospital, Muğla, Istanbul, Turkey
| | - Tuncay Centel
- Department of Orthopedic and Traumatology, Istanbul Memorial Hospital, Istanbul, Turkey
| |
Collapse
|
8
|
Cheng E, Mabee M, Swami VG, Pi Y, Thompson R, Dulai S, Jaremko JL. Ultrasound quantification of acetabular rounding in hip dysplasia: reliability and correlation to treatment decisions in a retrospective study. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:56-63. [PMID: 25438837 DOI: 10.1016/j.ultrasmedbio.2014.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/24/2014] [Accepted: 08/11/2014] [Indexed: 06/04/2023]
Abstract
Currently, acetabular rounding is only subjectively assessed on ultrasound for developmental dysplasia of the hip. We tested whether acetabular rounding can be quantified reliably and can distinguish between hips requiring and not requiring treatment. Consecutive infants (n = 90) suspected of having dysplasia of the hip, seen at a pediatric orthopedic clinic, were separated into four diagnostic categories (normal, borderline but resolved, treated by brace, treated surgically). Acetabular rounding was assessed by semi-quantitative grade (0 = nil, 1 = mild, 2 = moderate, 3 = severe) by three observers and by direct measurement of acetabular radius of curvature (AROC) by two observers. Inter-observer reliability of rounding grade was poor (κ = 0.30-0.37). AROC had an inter-observer intra-class correlation coefficient of 0.84 and coefficient of variation of 29%-34%. Mean AROC was significantly higher for hips requiring treatment than for those not requiring treatment (3.3 mm vs. 1.6 mm, p = 0.007). AROC reliably quantifies an observation currently being made subjectively by radiologists and surgeons, and may be useful as a supplementary ultrasound index of dysplasia of the hip in future prospective studies.
Collapse
Affiliation(s)
- Edwin Cheng
- Department of Radiology and Diagnostic Imaging, 2A2.41WC Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Myles Mabee
- Department of Biomedical Engineering, 1082 Research Translation Facility, University of Alberta, Edmonton, Alberta, Canada
| | - Vimarsha G Swami
- Department of Radiology and Diagnostic Imaging, 2A2.41WC Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Yeli Pi
- Department of Radiology and Diagnostic Imaging, 2A2.41WC Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Thompson
- Department of Biomedical Engineering, 1082 Research Translation Facility, University of Alberta, Edmonton, Alberta, Canada
| | - Sukhdeep Dulai
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, 2A2.41WC Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
9
|
Sulaiman A, Yusof Z, Munajat I, Lee N, Zaki N. Developmental dysplasia of hip screening using ortolani and barlow testing on breech delivered neonates. Malays Orthop J 2014; 5:13-6. [PMID: 25279029 DOI: 10.5704/moj.1111.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACT INTRODUCTION We conducted this study to compare the specificity and sensitivity of the Ortolani and Barlow tests performed by dedicated examiners, and to ascertain the incidence of developmental dysplasia of the hip (DDH) in breech babies. METHODS A dedicated examiner underwent specific training and testing by a paediatric orthopaedic surgeon. Routine examiners were medical officers who had basic training in medical school and were briefly trained by their superiors. The dedicated examiner examined 170 babies. Thirty babies including 5 babies with positive tests (according to the dedicated examiner) were examined by a blinded routine examiner. RESULTS of Ortolani and Barlow tests on 30 babies were compared with ultrasound examination by blinded radiologist. RESULTS Five babies had positive Ortolani and Barlow tests. The routine examiner did not detect positive Ortolani and Barlow tests. CONCLUSION The incidence of positive Ortolani and Barlow tests among breech babies was 2.8%. Result of Ortolani and Barlow tests by dedicated hip screener were better than results performed by routine examiner. KEY WORDS Ortolani and Barlow, Dedicated Examiner, Routine Examiner, Breech, Ultrasound.
Collapse
Affiliation(s)
- Ar Sulaiman
- Department of Orthopaedics, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan
| | - Zakaria Yusof
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II, Kota Bahru, Kelantan
| | - I Munajat
- Department of Orthopaedics, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan
| | - Naa Lee
- Department of Radiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan
| | - Nik Zaki
- Department of Obstetric and Gynaecology, School of Medical Sciences,Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan
| |
Collapse
|
10
|
Ömeroğlu H. Use of ultrasonography in developmental dysplasia of the hip. J Child Orthop 2014; 8:105-13. [PMID: 24510434 PMCID: PMC3965765 DOI: 10.1007/s11832-014-0561-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 01/23/2014] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Ultrasonography has been used as a diagnostic tool in developmental dysplasia of the hip (DDH) during early infancy since the early 1980s. The aim of this review article is to summarise the technique, benefits and shortcomings of four infantile hip ultrasonography methods, focusing mainly on the Graf method, and to assess the effectiveness of ultrasonographic newborn hip screening programmes. METHODS Several infantile hip ultrasonography methods have been defined to assess the relationship between the femoral head and acetabulum. The Graf, Harcke, Terjesen and Suzuki methods are the universally known ones. The Graf method is composed of a quantitative classification system, while the Harcke and Suzuki methods have qualitative definitions and the Terjesen method contains both quantitative and qualitative descriptions. RESULTS Although the results of several studies assessing the sensitivity and consistency of the ultrasonography methods have still not proven a clear dominance of one of these techniques, the primary advantage of the Graf method is that it has a standardised examination technique, as well as a very well defined numeric hip typing system. The importance of newborn hip screening has been universally accepted, but there is still no strong evidence regarding the superiority of either universal (screening of all newborns) or selective (screening of high-risk newborns) ultrasonographic newborn hip screening programmes. CONCLUSIONS An effective ultrasonographic method should include simple, precise, quantitative and consistent definitions for a proper examination and diagnosis. Both universal and selective ultrasonographic newborn hip screening programmes have significantly decreased the rate of late detected DDH and lessened the need for surgical treatment.
Collapse
Affiliation(s)
- Hakan Ömeroğlu
- Section of Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University Hospital, 26480 Eskisehir, Turkey
| |
Collapse
|
11
|
Ultrasonography in developmental dysplasia of the hip: what have we learned? Pediatr Radiol 2012; 42:1418-31. [PMID: 22940710 DOI: 10.1007/s00247-012-2429-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 04/16/2012] [Accepted: 05/13/2012] [Indexed: 12/18/2022]
Abstract
Developmental dysplasia of the hip (DDH) is an important but poorly defined entity, the natural history of which is incompletely understood. The term encompasses a disease spectrum ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Much controversy surrounds the diagnosis, imaging and management of this condition. We present a review of the history of US imaging of DDH from the radiologist's perspective, summarising the most widely recognised US methods described to date. We discuss controversies in the approach to US examination, with particular emphasis on current opinions. The existing scientific evidence for and variations in the practice of US screening for DDH, including recommendations from the United States Preventive Services Task Force and the ESPR DDH Taskforce Group respectively, are discussed.
Collapse
|
12
|
Bracken J, Tran T, Ditchfield M. Developmental dysplasia of the hip: controversies and current concepts. J Paediatr Child Health 2012; 48:963-72; quiz 972-3. [PMID: 23126391 DOI: 10.1111/j.1440-1754.2012.02601.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Developmental dysplasia of the hip is an important but poorly understood disorder as evidenced by the vast amount of literature published to date on this topic. The precise definition of hip dysplasia is controversial and it encompasses a spectrum of abnormalities, rather than a single condition, which at one end overlap with normal hip maturation. We review the risk factors, clinical examination and radiological imaging of the hip in the infant and young child, the controversies of ultrasound screening for hip dysplasia and the current management, both operative and non-operative, of this condition according to patient age.
Collapse
Affiliation(s)
- Jennifer Bracken
- Monash Children's, Royal Children's Hospital, Melbourne, Victoria, Australia.
| | | | | |
Collapse
|
13
|
Tréguier C, Chapuis M, Branger B, Bruneau B, Grellier A, Chouklati K, Proisy M, Darnault P, Violas P, Pladys P, Gandon Y. Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip. Eur Radiol 2012; 23:836-44. [PMID: 23080071 DOI: 10.1007/s00330-012-2635-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/04/2012] [Accepted: 07/10/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To propose an easy and reproducible sonographic screening test able to avoid late presentation of developmental dysplasia of the hip (DDH). METHODS The pubo-femoral distance (PFD) cut-off point was determined on 980 infants who underwent ultrasonography of the hips in comparison with the final diagnosis, based on clinical, ultrasound data and follow-up. PFD reproducibility was tested on 52 hips by both an experienced and an inexperienced radiologist. After teaching this screening method to general radiologists, its impact was evaluated by analysing the rate of late diagnosis in an entire administrative area. RESULTS An abnormal PFD threshold above 6 mm gave a sensitivity of 97.4 % for the diagnosis of DDH (271 hips) and a specificity of 84 %. Sensitivity increased to 100 % when taking into consideration children of 1 month or older. The PFD measurement stayed reproducible even in inexperienced hands (k = 0.795). For 3 years, following the extension of screening to all female infants, there was no late diagnosis of DDH in girls in amongst a catchment area of 1 million inhabitants. CONCLUSIONS PFD measurement with a threshold for abnormality of 6 mm at the age of 1 month, without asymmetry above 1.5 mm, could eradicate DDH late diagnosis.
Collapse
Affiliation(s)
- C Tréguier
- Department of Radiology, Hôpital Sud, University Hospital, Rennes, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Peterlein CD, Fuchs-Winkelmann S, Schüttler KF, Lakemeier S, Timmesfeld N, Görg C, Schofer MD. Does probe frequency influence diagnostic accuracy in newborn hip ultrasound? ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1116-1120. [PMID: 22579539 DOI: 10.1016/j.ultrasmedbio.2012.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 02/04/2012] [Accepted: 02/28/2012] [Indexed: 05/31/2023]
Abstract
Ultrasonography of the hip has gained wide acceptance as reliable method for diagnosing developmental hip dysplasia in infants. This blinded study was conducted to investigate the influence of two linear probes with different frequency on diagnostic accuracy and reproducibility. In 206 consecutive newborns, the bony roof angle (α-angle) and cartilage roof angle (β-angle) were assessed by three investigators according to Graf. The hips were measured twice both with a 7.5 MHz and a 12 MHz linear transducer (Sonoline G60S(®) ultrasound system; Siemens, Erlangen, Germany). Each investigator evaluated his sonograms 6 weeks later. Depending on the mean values for α-angle and β-angle, the hips were classified. Reproducibility of the Graf classification was not found to be influenced. In two of three investigators, we observed significant improvement concerning variation of the β-angle with the 12 MHz probe. The use of high-resolution transmitters may improve diagnostic accuracy in ultrasonography of the newborn's hip.
Collapse
|
15
|
Loder RT, Skopelja EN. The epidemiology and demographics of hip dysplasia. ISRN ORTHOPEDICS 2011; 2011:238607. [PMID: 24977057 PMCID: PMC4063216 DOI: 10.5402/2011/238607] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 06/17/2011] [Indexed: 12/18/2022]
Abstract
The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing.
Collapse
Affiliation(s)
- Randall T. Loder
- Section of Orthopedic Surgery, Riley Hospital for Children, ROC 4250, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
- Department of Orthopaedic Surgery, Indiana University, Indianapolis, IN 46202, USA
| | - Elaine N. Skopelja
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| |
Collapse
|
16
|
Kosar P, Ergun E, Gökharman FD, Turgut AT, Kosar U. Follow-up sonographic results for Graf type 2A hips: association with risk factors for developmental dysplasia of the hip and instability. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:677-683. [PMID: 21527616 DOI: 10.7863/jum.2011.30.5.677] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purpose of the study was to evaluate the association of sonographic worsening in type 2a hips with risk factors of developmental dysplasia of the hip, stability of the hip, and initial sonographic findings. METHODS Among infants who were referred for hip sonography between 2007 and 2009, 3450 were included in this study. Sonographic examinations were performed by combining the static Graf technique and the dynamic Harcke technique. The rate of sonographic worsening in type 2a hips and the relationship between sonographic worsening and risk factors for developmental dysplasia, instability of the hip, lateralization (right or left) of immaturity, and the presence of unilateral and bilateral immature hips were evaluated. RESULTS Type 2a hips were observed in 529 infants (15.3%; 780 hips [11.3%]). Of these, in 36 cases (6.8%; 44 hips [5.6%]), the sonographic results worsened. Twenty-five of these 36 cases (32 of 44 hips) were diagnosed as type 2 b; in others, the dysplasia worsened, and 6 cases (7 hips) were classified as type 2 c, 3 cases (3 hips) as type D, and 2 cases (2 hips) as type 3. Instability, unilateral type 2a hips, and associated central nervous system anomalies were found to be independent predictors of sonographic worsening in type 2a hips. CONCLUSIONS Type 2a hips may worsen sonographically at a rate of 5.6%; hence, sonographic follow-up is needed. Instability, central nervous system anomalies, and unilateral type 2a hips were found to be independent predictors of sonographic worsening. Our study shows that cases with these risk factors should be followed more carefully.
Collapse
Affiliation(s)
- Pinar Kosar
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | | | | | | | | |
Collapse
|
17
|
Copuroglu C, Ozcan M, Aykac B, Tuncer B, Saridogan K. Reliability of ultrasonographic measurements in suspected patients of developmental dysplasia of the hip and correlation with the acetabular index. Indian J Orthop 2011; 45:553-7. [PMID: 22144750 PMCID: PMC3227361 DOI: 10.4103/0019-5413.87131] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ultrasonography is accepted as a useful imaging modality in the early detection of developmental dysplasia of the hip (DDH). Early detection and early treatment of DDH prevents hip dislocation and related physical, social, economic, and psychological problems. The purpose of this study was to evaluate the reliability of ultrasonographic and roentgenographic measurements measured by seven different observers. MATERIALS AND METHODS The alpha angles of 66 hips in 33 patients were measured using the Graf method by seven different observers. Acetabular index degrees on plane roentgenograms were measured in order to assess the correlation between the ultrasonographic alpha angle and the radiographic acetabular index, which both show the bony acetabular depth, retrospectively. RESULTS The interclass correlation coefficient, measuring the interobserver reliability, was high and statistically significant for the ultrasonographic measurements. There was a negative correlation between the alpha angle and the acetabular index. CONCLUSIONS Ultrasonography, when applied properly, is a reliable technique between different observers, in the diagnosis and follow up of DDH. When assessed concomitantly with the roentgenographic measurements, the results are reliable and statistically meaningful.
Collapse
Affiliation(s)
- Cem Copuroglu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Trakya University, Edirne, Turkey,Address for correspondence: Dr. Cem Copuroglu, Department of Orthopaedics and Traumatology, Trakya University Medical Faculty, 22030 Edirne, Turkey. E-mail:
| | - Mert Ozcan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Bilal Aykac
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Beyti Tuncer
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Kenan Saridogan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| |
Collapse
|
18
|
Peterlein CD, Schüttler KF, Lakemeier S, Timmesfeld N, Görg C, Fuchs-Winkelmann S, Schofer MD. Reproducibility of different screening classifications in ultrasonography of the newborn hip. BMC Pediatr 2010; 10:98. [PMID: 21184670 PMCID: PMC3022795 DOI: 10.1186/1471-2431-10-98] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 12/24/2010] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Ultrasonography of the hip has gained wide acceptance as a primary method for diagnosis, screening and treatment monitoring of developmental hip dysplasia in infants. The aim of the study was to examine the degree of concordance of two objective classifications of hip morphology and subjective parameters by three investigators with different levels of experience. METHODS In 207 consecutive newborns (101 boys; 106 girls) the following parameters were assessed: bony roof angle (α-angle) and cartilage roof angle (β-angle) according to Graf's basic standard method, "femoral head coverage" (FHC) as described by Terjesen, shape of the bony roof and position of the cartilaginous roof. Both hips were measured twice by each investigator with a 7.5 MHz linear transducer (SONOLINE G60S® ultrasound system, SIEMENS, Erlangen, Germany). RESULTS Mean kappa-coefficients for the subjective parameters shape of the bony roof (0.97) and position of the cartilaginous roof (1.0) demonstrated high intra-observer reproducibility. Best results were achieved for α-angle, followed by β-angle and finally FHC. With respect to limits of agreement, inter-observer reproducibility was calculated less precisely. CONCLUSIONS Higher measurement differences were evaluated more in objective scorings. Those variations were observed by every investigator irrespective of level of experience.
Collapse
Affiliation(s)
- Christian D Peterlein
- Department of Orthopaedics and Rheumatology, University Hospital Giessen and Marburg, Marburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
19
|
Evaluation of a training program for general ultrasound screening for developmental dysplasia of the hip in preventive child health care. Pediatr Radiol 2010; 40:1634-9. [PMID: 20544189 DOI: 10.1007/s00247-010-1689-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 03/12/2010] [Accepted: 03/21/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND A research study in the Netherlands showed that general ultrasound (US) screening was cost-effective in the detection of developmental dysplasia of the hip (DDH). This study was followed by a pilot implementation study. Part of this pilot implementation study is to investigate whether professionals of the infant health care (IHC) system, with no previous US experience, would be able to perform US of the hip. OBJECTIVE This study looks at health care worker ability to classify US images into a modified Graf system. MATERIALS AND METHODS After theoretical and practical training, seven nurses and physicians of the participating IHC centers reported their findings on sonographic images of 80 children. This was repeated five months later. From the two evaluation moments the intraobserver agreement and the interobserver agreement was determined. RESULTS The average estimated interobserver Cohen's kappa for both sessions was for nurses 0.6 and for physicians 0.5. The second evaluation showed a decrease from an average of 4.3% missed cases per screener to 2.3% and an increase of an average of 5% false positives per screener to 9.1%. CONCLUSION The inter- and intra-observer agreement is comparable to similar studies in which the participants had a professional background in US examination. The level of agreement of the trainees in the perspective of the screening process was considered sufficient for the pilot implementation project.
Collapse
|
20
|
Abstract
In its severest form, developmental dysplasia of the hip is one of the most common congenital malformations. The pathophysiology and natural history of the range of morphological and clinical disorders that constitute developmental dysplasia of the hip are poorly understood. Neonatal screening programmes, based on clinical screening examinations, have been established for more than 40 years but their effectiveness remains controversial. Whereas systematic sonographic imaging of newborn and young infants has afforded insights into normal and abnormal hip development in early life, we do not clearly understand the longer-term outcomes of developmental hip dysplasia, its contribution to premature degenerative hip disorders in adult life, and the benefits and harms of newborn screening. High quality studies of the adult outcomes of developmental hip dysplasia and the childhood origins of early degenerative hip disease are needed, as are randomised trials to assess the effectiveness and safety of neonatal screening and early treatment.
Collapse
Affiliation(s)
- Carol Dezateux
- Centre of Epidemiology for Child Health, Institute of Child Health, London, UK.
| | - Karen Rosendahl
- Section for Radiology, University of Bergen, Bergen, Norway; Department of Imaging, Great Ormond Street Hospital for Children, London, UK
| |
Collapse
|
21
|
Rosendahl K, Toma P. Ultrasound in the diagnosis of developmental dysplasia of the hip in newborns. The European approach. A review of methods, accuracy and clinical validity. Eur Radiol 2007; 17:1960-7. [PMID: 17235535 DOI: 10.1007/s00330-006-0557-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 11/24/2006] [Accepted: 12/01/2006] [Indexed: 01/19/2023]
Abstract
Based on soft evidence that ultrasound screening tends to reduce the rate of late developmental dysplasia of the hip (DDH) and the need for surgical interventions, different screening strategies including universal or selective ultrasound screening have been established in several European countries and centres during the last decade. We performed an extensive search for articles on ultrasound diagnosis of developmental dysplasia of the hip over the last 26 years. A few studies reported an adequate repeatability for the static [Graf, Morin, modified Morin (Terjesen)] and for the combined static/dynamic methods [modified Graf (Rosendahl)], while no such reports were found for the dynamic (Harcke) ultrasound techniques. The effect of newborn ultrasound screening on late DDH have been addressed in two randomised trials (RCTs), both concluding that both selective and universal ultrasound screening tend to reduce the prevalence of subluxed or dislocated DDH, thus without reaching statistical significance. Finally, several observational studies have shown that morphologically normal hips tend to remain normal with or without a co-existing instability, and 97% of sonographically immature hips tend to normalise spontaneously within 3 months. Two studies report on a similar pattern for mildly dysplastic, but stable hips. From the data available we suggest that selective ultrasound screening is worthwhile in areas with a high prevalence of late cases, given a well-organised, high-quality service can be provided.
Collapse
Affiliation(s)
- Karen Rosendahl
- Department of Imaging, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK.
| | | |
Collapse
|
22
|
Roposch A, Moreau NM, Uleryk E, Doria AS. Developmental dysplasia of the hip: quality of reporting of diagnostic accuracy for US. Radiology 2006; 241:854-60. [PMID: 17053199 DOI: 10.1148/radiol.2413051358] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To systematically review the quality of diagnostic accuracy reporting in studies on the use of ultrasonography (US) for the diagnosis of developmental dysplasia of the hip (DDH). MATERIALS AND METHODS A systematic review of the MEDLINE, EMBASE, DARE, and Cochrane Library databases was performed by using a validated search strategy. Two independent reviewers evaluated articles by using the Standards for Reporting of Diagnostic Accuracy (STARD) and Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Reviews (QUADAS) statements. Items were reported individually for STARD and QUADAS because these instruments do not incorporate a summary score. A simple kappa statistic with 95% confidence intervals was used to measure the level of agreement between the two reviewers. RESULTS Ten studies were included. In three studies, reliability was investigated, and in seven studies elements of both validity and reliability were investigated. In no study did the authors adequately report more than 40% of the STARD items. The quality of methods that were used in the studies was poor. Only one (14%) of seven studies provided information on more than 50% of the QUADAS items. All studies included a good description of image acquisition, but data analysis was imperfect and lacked estimates of diagnostic accuracy and precision. Authors tended to overinterpret their results. CONCLUSION Overall, there was imperfect reporting of diagnostic accuracy in studies on the use of US for diagnosis of DDH.
Collapse
Affiliation(s)
- Andreas Roposch
- Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, Institute of Child Health, University College London, Great Ormond St, London WC1N 3JH, England.
| | | | | | | |
Collapse
|
23
|
Tukenmez M, Percin S, Arslan M, Tezeren G. Use of ultrasound for diagnosis of interposition of soft tissue in bone fracture line. ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:197-200. [PMID: 16464665 DOI: 10.1016/j.ultrasmedbio.2005.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 10/24/2005] [Accepted: 11/03/2005] [Indexed: 05/06/2023]
Abstract
Ultrasound (US) has recently become a favorable diagnostic technique in orthopedics and traumatology, as well as in other medical sciences. We aimed to determine effectiveness of US in diagnosis of soft tissue interposition that impedes or delays the union of fracture. The present study included 55 acute fractures in 39 patients, in whom operation (open reduction and internal fixation) was scheduled because no closed reduction was achieved, in our department between January 1999 and December 2003. Before the operation, the fracture line in all patients was scanned by a 5- to 7-MHz linear probe of the US device. The data obtained by US examination were compared to findings obtained by surgical intervention with the McNemar test. These were calculated as positive predictive value and negative predictive value, with specificity and sensitivity. The difference between the study and control groups was not statistically significant (p = 0.625). These findings demonstrated that sensitivity value, specificity value, positive and negative predictive values were 96.9%, 86.3%, 91.4% and 95%, respectively. US is an efficient, safe and reliable diagnostic technique for detection of interposition of soft tissue in bone fracture line.
Collapse
Affiliation(s)
- Mehmet Tukenmez
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
| | | | | | | |
Collapse
|
24
|
Liu LL, Gallaher MM, Davis RL, Rutter CM, Lewis TC, Marcuse EK. Use of a respiratory clinical score among different providers. Pediatr Pulmonol 2004; 37:243-8. [PMID: 14966818 DOI: 10.1002/ppul.10425] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Respiratory assessment of children with asthma or bronchiolitis is problematic because both the components of the assessment and their relative importance vary among care providers. Use of a systematic standard assessment process and clinical score may reduce interobserver variation. Our objective was to determine observer agreement among physicians (MD), nurses (RN), and respiratory therapists (RT), using a standard respiratory clinical score. A clinical score was developed incorporating four physiologic parameters: respiratory rate, retractions, dyspnea, and auscultation. One hundred and sixty-five provider pairs (e.g., MD-MD, RN-RT) independently assessed a total of 55 patients admitted for asthma, bronchiolitis, or wheezing at an urban tertiary-care hospital. A weighted kappa statistic measured agreement beyond chance. Rater pairs had high observed agreement on total score of 82-88% and weighted kappas ranging from 0.52 (MD-RN; 95% CI, 0.19, 0.79) to 0.65 (RN-RN; 95% CI, 0.46, 0.87). Observed agreement on individual components of the score ranged from 58% (auscultation) to 74% (dyspnea), with unweighted kappas of 0.36 (respiratory rate; 95% CI, 0.26, 0.46) to 0.53 (dyspnea; 95% CI, 0.41, 0.65). In conclusion, this respiratory clinical score demonstrates good interobserver agreement between MDs, RNs, and RTs. Future research is needed to examine validity and responsiveness in clinical settings. By standardizing respiratory assessments, use of a clinical score may facilitate care coordination by physicians, nurses, and respiratory therapists and thereby improve care of children hospitalized with asthma and bronchiolitis.
Collapse
Affiliation(s)
- Lenna L Liu
- Child Health Institute, University of Washington, Seattle, Washington 98115-8160, USA.
| | | | | | | | | | | |
Collapse
|
25
|
Tomà P, Valle M, Rossi U, Brunenghi GM. Paediatric hip--ultrasound screening for developmental dysplasia of the hip: a review. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 2001; 14:45-55. [PMID: 11567854 DOI: 10.1016/s0929-8266(01)00145-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper will try to deal with the following questions: Which is the correct screening model for the developmental dysplasia of the hip (DDH)? What is the clinical significance of "sonographic" DDH? Can overtreatment produced by ultrasound (US) screening cause a waste of resources and eventually morbidity? We reviewed the literature since January, 1996 through December, 2000. To compare our experience with the literature, we analysed the results of the US examinations of the hip performed in our Institute. Over 4 years of US screening 11326 infants (22652 hips), aged 3 days to 4 months, were examined consecutively. Sonographic hip findings were abnormal in 531 infants (4.7%). The screening showed 381 subjects (3.36% of the population) with a type IIa hip (bilateral or unilateral); 65% of these infants were normal at follow up and only 35% worsened. On the whole we treated 282 infants (2.5%). No open reduction was performed. Avascular necrosis appeared in 2/282 treated cases (1.06%). We support the routine generalised US screening of neonatal hips. The excess of doubtful cases and, consequently, of the extra referrals may be limited, and the overtreatment decreased to the lowest rates reported by optimisation of everyone's approach.
Collapse
Affiliation(s)
- P Tomà
- Radiology/Orthopaedy II. G. Gaslini Institute, Largo Gaslini 5, I-16148 Genoa, Italy.
| | | | | | | |
Collapse
|
26
|
Affiliation(s)
- S Wientroub
- Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Israel
| | | |
Collapse
|