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Miras Aguilar I, Fidalgo Marrón L, Pangua Gómez M, Olteanu Olteanu FC, Gilarte Herrera CE, Sevilla Ramos P, Mateo Martínez G, Montes Martín L, Ortigado Matamala A. ECAD study: Evaluating agreement degree among paediatricians in hip dysplasia assessment by the Graf ultrasound method. Eur J Pediatr 2024:10.1007/s00431-024-05725-x. [PMID: 39179894 DOI: 10.1007/s00431-024-05725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/01/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024]
Abstract
Developmental dysplasia of the hip (DDH) is the most common musculoskeletal anomaly of childhood. This study analyses paediatrician's concordance performing hip ultrasound according to Graf's method. An analytical cross-sectional study is designed. Patients' hips are evaluated by Graf's ultrasound method at 4-6 and 12-16 weeks of age. Demographic characteristics, pregnancy history, factors related to DDH, hip type, and α and β angles are collected. To assess the agreement degree of hip diagnosis and hip types Kappa index (I. kappa) is used. Intraclass correlation coefficient (ICC) evaluates the concordance of α and β angles. A p value < 0.05 is considered statistically significant. All results are represented with their 95% confidence interval (95% CI). Four hundred sixty-seven neonates are recruited and meet the inclusion criteria. A total of 3182 images were analysed. Agreement between paediatricians according to hip diagnosis and different types ranges from moderate to almost perfect I. kappa 0.6-1.0 (95% CI 0.5-0.7; 95% CI 1.0-1.0). α angle ICC for paediatricians is between 0.75 and 0.88 (95% CI 0.61-0.86; 95% CI 0.80-0.92). β angle value agreement degree among paediatricians at both visits is moderate. The Graf method is the most popular ultrasound technique for hip assessment. In our setting, paediatricians carry out children follow-up; therefore, they should perform universal screening. In this study agreement degree between paediatricians varies between substantial and almost perfect. Conclusion: The Graf ultrasound procedure performed by paediatricians is a reliable test and can be used for DDH screening. What is Known • Developmental dysplasia of the hip (DDH) is the most common congenital musculoskeletal anomaly of childhood. Early diagnosis and treatment improve DDH prognosis. Lack of detection can cause complications such as lameness, early osteoarthritis and need for hip replacement at an early age. What is New • Today, the best screening method is still subject of debate. But it seems that with selective screening many pathological hips go unnoticed. Universal screening implementation may be a challenge in some countries. But the question is if this could be carried out by paediatricians as part of healthy child follow-up.
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Affiliation(s)
- Isabel Miras Aguilar
- Paediatrics and Neonatology Department, Getafe University Hospital, Carr. Madrid - Toledo, Km 12,500, 280905, Madrid, Getafe, Spain.
- University of Alcala, Alcalá de Henares, Spain.
| | - Laura Fidalgo Marrón
- Paediatrics Department, Guadalajara University Hospital, C. Donante de Sangre, S/N, 19002, Guadalajara, Castilla La Mancha, Spain
- University of Alcala, Alcalá de Henares, Spain
| | - María Pangua Gómez
- Paediatrics Department, Guadalajara University Hospital, C. Donante de Sangre, S/N, 19002, Guadalajara, Castilla La Mancha, Spain
- University of Alcala, Alcalá de Henares, Spain
| | - Filip Camil Olteanu Olteanu
- Paediatrics Department, Guadalajara University Hospital, C. Donante de Sangre, S/N, 19002, Guadalajara, Castilla La Mancha, Spain
| | - Cristina Eugenia Gilarte Herrera
- Paediatrics Department, Guadalajara University Hospital, C. Donante de Sangre, S/N, 19002, Guadalajara, Castilla La Mancha, Spain
| | - Pilar Sevilla Ramos
- Paediatrics Department, Guadalajara University Hospital, C. Donante de Sangre, S/N, 19002, Guadalajara, Castilla La Mancha, Spain
| | - Gonzalo Mateo Martínez
- Paediatrics Department, Guadalajara University Hospital, C. Donante de Sangre, S/N, 19002, Guadalajara, Castilla La Mancha, Spain
| | | | - Alfonso Ortigado Matamala
- Paediatrics Department, Guadalajara University Hospital, C. Donante de Sangre, S/N, 19002, Guadalajara, Castilla La Mancha, Spain
- University of Alcala, Alcalá de Henares, Spain
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Haertlé M, Hawi H, Windhagen H, Becker N, Ahmad SS. Fifty percent of patients undergoing periacetabular osteotomy for hip dysplasia showed normal findings upon neonatal ultrasound screening : Symptomatic hip dysplasia in adulthood despite inconspicuous neonatal hip ultrasound. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:313-319. [PMID: 36930261 PMCID: PMC10063490 DOI: 10.1007/s00132-023-04357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/18/2023]
Abstract
Developmental dysplasia of the hip (DDH) is characterized by the pathomorphology of inadequate acetabular coverage of the femoral head leading to increased loading of the articular surface and acetabular rim. If left untreated, this ultimately leads to osteoarthritis. Germany introduced a nationwide universal ultrasound screening program for all newborn infants in 1996. Subsequently, the incidence of undiagnosed hip dislocation was significantly reduced. In this consecutive series of patients who underwent periacetabular osteotomy for the treatment of symptomatic dysplasia of the hip between October 2014 and October 2022 data regarding the U3 screening examination were analyzed. The data included whether the examination was performed, whether the findings were positive or negative, whether the patients underwent any form of treatment in the case of a positive finding and whether a control X‑ray was performed. This study provides evidence that acetabular undercoverage cannot be ruled out based on a normal finding in ultrasonography screening. Furthermore, the study also shows that residual dysplasia may persist despite attempts of conservative treatment.
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Affiliation(s)
- Marco Haertlé
- Klinik für Orthopädie der Medizinischen Hochschule Hannover im Annastift, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany
| | - Harun Hawi
- Klinik für Orthopädie der Medizinischen Hochschule Hannover im Annastift, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany
| | - Henning Windhagen
- Klinik für Orthopädie der Medizinischen Hochschule Hannover im Annastift, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany
| | - Nils Becker
- Klinik für Orthopädie der Medizinischen Hochschule Hannover im Annastift, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany
| | - Sufian S Ahmad
- Klinik für Orthopädie der Medizinischen Hochschule Hannover im Annastift, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany.
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