Developmental dysplasia of the hip (DDH) occurs in 3–5 of 1000 live births and is associated with known risk factors. In most countries, formal practice for early detection of DDH entails the combination of risk factor identification and physical examination of the hip, while the golden standard diagnostic instrument is hip ultrasonography (US). This practice is commonly referred to as selective screening. Infants with positive US findings are treated with a Pavlik harness, a dynamic abduction splint.
The objective of our study was to evaluate hip US utilization patterns in Maccabi Healthcare Services (MHS), a large health plan.
Study population: All MHS members, born between June 2011 and October 2014, who underwent at least one US before the age of 15 months. Study variables: Practice specialty and number of enrolled infants. Positive US result was defined as referral to an abduction splint. Cost was based on Ministry of Health price list. Chi square and correlation coefficients were employed in the statistical analysis.
Of the 115,918 infants born during the study period, 67,491 underwent at least one hip US. Of these, 60.6% were female, mean age at performance: 2.2 months. Of those who underwent US, 625 (0.93%) were treated with a Pavlik harness: 0.24% of the male infants and 1.60% of the female infants (p < 0.001). Analysis of physician practice characteristics revealed that referral to US was significantly higher among pediatricians as compared with general practitioners (60% and 35%, respectively). Practice volume had no influence on referral rate. Direct medical costs of the 107 hip US examinations performed that led to detection of one positive case (treated by Pavlik): US$10,000.
Current pattern of hip US utilization for early detection of DDH resembles universal screening more closely than selective screening. This can inform policy decisions as to whether a stricter selective screening or a formal move to universal screening is appropriate in Israel.
Committee SMA. Screening for the detection of congenital dislocation of the hip. Arch Dis Child. 1986;61:921–6. CrossRef
Americal Academy of Pediatrics. Clinical practice guideline: early detection of developmental dysplasia of the hip. Pediatrics. 2000;105(4):896-905.
American College of Radiology. ACR Appropriateness Criteria: Developmental dysplasia of the hip-child. Date of origin: 1999. Last review date: 2013. https://acsearch.acr.org/docs/69437/Narrative. Accessed 31 May 2017.
Eidelman M, Katzman A, Freiman S, Peled E, Bialik V. Treatment of true developmental dysplasia of the hip using Pavlik's method. J Pediatr Orthop B. 2003;12(4):253–8. PubMed
Elbourne D, Dezateux C, Arthur R, Clarke NM, Gray A, King A, Quinn A, Gardner F, Russell G. UK collaborative hip trial group. Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK hip trial): clinical and economic results of a multicentre randomised controlled trial. Lancet. 2002;360(9350):2009–17. CrossRefPubMed
Shorter D, Hong T, Osborn DA. Screening programs for developmental dysplasia of the hip in newborn infants. Cochrane Database Syst Rev. 2011, Issue 9. Art. No.: CD004595. DOI: 10.1002/14651858.CD004595.pub2.
Cashman JP, Round J, Taylor G, Clarke NM. The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. Bone Joint J. 2002;84(3):418–25. CrossRef
Holen KJ, Tegnander A, Bredland T, Johansen OJ, Sæther OD, Eik-Nes SH, Terjesen T. Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomized trial of 15,529 newborn infants. Bone Joint J. 2002;84(6):886–90. CrossRef
Gray A, Elbourne D, Dezateux C, King A, Quinn A, Gardner F. Economic evaluation of ultrasonography in the diagnosis and management of developmental hip dysplasia in the United Kingdom and Ireland. J Bone Joint Surg Am. 2005;87(11):2472–9. PubMed
Tabenkin H, Lahad A. The Israeli task force on health promotion and preventive medicine: Clinical guidelines. The Israel Association of Family Physicians and the Israeli Medical Association. 2013. (First publication - 2000; revised in 2004, 2008 and 2013). (in Hebrew).
Dor M. Identification of hip joint instability in neonates and infants. Instructions of the Ministry of Health, based on the recommendation of the National Council on Pediatrics and Child Health, 2014, Jerusalem. Also available at http://www.health.gov.il/hozer/mr17_2007.pdf. Accessed 17 Mar 2017. (in Hebrew).
Laborie LB, Markestad TJ, Davidsen H, Brurås KR, Aukland SM, Bjørlykke JA, Reigstad H, Indrekvam K, Lehmann TG, Engesæter IØ, et al. Selective ultrasound screening for developmental hip dysplasia: Effect on management and late detected cases. A prospective survey during 1991-2006. Pediatr Radiol. 2014;44(4):410–24. CrossRefPubMed
- Utilization of ultrasonography to detect developmental dysplasia of the hip: when reality turns selective screening into universal use
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