Newborn Hip Screenings at 4 to 8 Weeks Are Optimal in Predicting Referral and Treatment Outcomes: A Retrospective Review ()
Affiliation(s)
1Taiji Clinic, Taipei city.
2Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu.
3Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan.
4Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien.
5Taiwan Adventist Hospital, Taipei city.
6Chang Gung Memorial Hospital, Taoyuan.
ABSTRACT
Optimal DDH screening timing and whether adding risk
profiles could aid in detecting treatment outcome were investigated. Risk
factors were employed to supplement ultrasound findings in flagging cases for
follow-up. Initial screening results and harness treatment outcomes concordance
were compared at different screening ages and screening protocols. Using
clinical decision to supplement ultrasound screening allowed to accurately flag
all 12 DDH treated cases upon initial visit. Clinical decision correctly
identified cases that would have otherwise been missed (n = 2). However, doing
so increased the rate of false positive cases at all time points of initial
screening. Initial screens were more accurate for predicting treatment outcomes
when using ultrasound only if done after 28 days [≤28 days (88.1%) vs. 29 - 56
days (98.5%), OR = 7.16, p < 0.001] or ultrasound with clinical decision [≤28
days (86.4%) vs. 29 - 56 days (95.7%), OR = 3.00, p < 0.001]. In contrast,
screening after 56 days failed to marginally improve accuracy compared to
screens done between 29 - 56 days, regardless of the screening protocol
employed. Two important trade-offs emerged. First, when choosing timing of
initial screening, optimal accuracy and harness treatment schedule should both
be considered. Second, when considering whether to use a more conservative risk
profile to supplement ultrasound findings, treatment accuracy and the ability
to efficiently detect cases requiring harness treatment should both be considered.
We provide evidence for performing an initial DDH ultrasound screen between 4
and 8 weeks (29 - 56 days), while employing clinical decision to aid in determining
cases that require further follow-up evaluation.
Share and Cite:
Lussier, E. , Lei, W. , Sun, Y. , Chen, H. , Chang, T. and Chang, C. (2020) Newborn Hip Screenings at 4 to 8 Weeks Are Optimal in Predicting Referral and Treatment Outcomes: A Retrospective Review.
Open Journal of Pediatrics,
10, 332-346. doi:
10.4236/ojped.2020.102034.