Pediatric Rheumatology Online Journal → August 2003 → Miscellaneous Clinical Studies and Case Reports → Abstract #198

AUDITING HIP ULTRASOUND SCREENING OF INFANTS AT INCREASED RISK OF DEVELOPMENTAL DYSPLASIA OF THE HIP

C. A. Lowry,¹ V. B. Donoghue,¹ J. F. Murphy.¹

¹Department of Neonatology, Mational Maternity Hospital, Dublin, Dublin, Ireland

Background : Clinical examination, whilst useful, has been shown to be insufficient as the sole screening method in infants. Ultrasound examination at eight weeks in high risk infants is an integral part of the screening process. In this study we aim to demonstrate the rate of developmental dysplasia of the hips in those without clinically dislocated hips and the cost benefit analysis of such screening.
Methods : Included in our study were all infants born in National Maternity Hospital between January 1994 and December 2001. All those with clinically dislocated hips were treated by a Pavlik harness and referred for follow-up to a paediatric orthopaedic surgeon. An eight week hip ultrasound scan was performed for those infants with stable hips on examination but the following criteria ; (1) a first degree relative with congenital dislocation of hips, (2) breech presentation at birth, (3) a persistent "click" at birth in an otherwise stable hip. All ultrasound scans were performed by the same radiologist (VBD). Using the Graf technique.
Results : During the period of study a total of 52,893 infants were born in the National Maternity Hospital. Based upon risk factor profile a total of 5,485 hip ultrasound scans were performed by our radiologist. Of those scanned 18(0.33%) were found to have dislocated hips and 153(2.78%) to have dysplastic hips. The scans take approx. twelve minutes, total scanning time of 1,097 hours, in terms of consultant scanning time this approximates to 4,750 euro per dislocated hip. The 32 infants with dislocation were treated with Pavlik harness the remaining 153 were followed up by serial ultrasound examinations but did not require active intervention.
Conclusions : This study demonstrates the ultrasound pick up rate of abnormal hips among infants who, although clinically normal but at high risk of DDH, is worthwhile. The cost of 3,809 euro per detected case is cost effective in light of the toll and morbidity associated with late diagnosis, prolonged hospitalisation and surgery.