BMJ  2005;330:1413 (18 June), doi:10.1136/bmj.38450.646088.E0 (published 1 June 2005)

Paper

Ultrasonography in screening for developmental dysplasia of the hip in newborns: systematic review

¹ Centre for Reviews and Dissemination, University of York, York YO10 5DD, ² Horten Centre, University of Zurich, Zurich, Switzerland

Objective To assess the accuracy and effectiveness of the screening of all newborn infants for developmental dysplasia of the hip (DDH) using ultrasound imaging, as is standard practice in some European countries but not in the United Kingdom, the United States, or Scandinavia.

Design Systematic review.

Data sources Twenty three medical, economic, and grey literature databases (to March 2004), with no limitations of design or language; some references were provided by experts.

Selection of studies Only diagnostic accuracy studies and comparative studies conducted in an unselected newborn population were eligible for the review. Two reviewers independently selected the studies and performed the quality assessment.

Results The review identified one diagnostic accuracy study, and this was of limited quality. In this study the reference standard was treatment up to age of 8 months or an abnormal ultrasound finding at age 8 months. Ultrasound screening had a sensitivity of 88.5% (95% confidence interval 84.1% to 92.1%), specificity of 96.7% (96.4% to 97.4%), a positive predictive value of 61.6% and a negative predictive value of 99.4%. Ten studies evaluated the impact of ultrasound in screening, but these too had various methodological weaknesses, limiting the reliability of their findings. Compared with clinical screening, general ultrasound screening in newborns may increase overall treatment rates, but ultrasound screening seems to be associated with shorter and less intrusive treatment.

Conclusions Clear evidence is lacking either for or against general ultrasound screening of newborn infants for DDH. Studies that investigate the natural course of the disorder, the optimal treatment for DDH, and the best strategy for ultrasound screening are needed.

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We need more evidence on ultrasound screening for DDH
BMJ 2005 330: 0. [Full Text] [PDF]

This article has been cited by other articles:

• Shipman, S. A. (2009). Risk Management and Developmental Dysplasia of the Hip: Primum Non Nocere. Pediatrics 123: e546-e546 [Full text]  
• Roposch, A., Wright, J. G. (2007). Increased Diagnostic Information and Understanding Disease: Uncertainty in the Diagnosis of Developmental Hip Dysplasia. Radiology 242: 355-359 [Abstract] [Full text]  
• Roposch, A., Moreau, N. M., Uleryk, E., Doria, A. S. (2006). Developmental Dysplasia of the Hip: Quality of Reporting of Diagnostic Accuracy for US. Radiology 241: 854-860 [Abstract] [Full text]  
• (2006). Other articles noted. Evid. Based Med. 11: 63-64 [Full text]  

Rapid Responses:

Read all Rapid Responses

Developmental Dysplasia of the Hip Screening - a never ending story

Jose R Fernandez Alvarez, et al.
bmj.com, 3 Aug 2005 [Full text]

Unsystematic review on ultrasound screening for DDH

Karen Rosendahl
bmj.com, 9 Oct 2005 [Full text]

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