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GPs go forth

GPs ‘should carry out additional infant hip screening’

Researchers have called for GPs to carry out an additional hip screening test in infants at three to four months after a study showed the current hip check at six to eight weeks misses some cases of hip dysplasia and may give parents false reassurance. 

In the first formal audit of the current hip screening programme which has been in place for 35 years, an analysis of more than 70,000 children in the north of England found the infant hip check to be poor at predicting problems.

The study of all children who had been referred after the routine hip check as well as any children who were picked up later showed the test had a sensitivity of 16.7% and positive predictive value of 3.5%.

Over the 15-year study period, 170 babies were referred, six were diagnosed with developmental dysplasia of the hip and another 30 children were found to have presented later with the condition.

It also showed that specific signs of instability including a positive Ortolani or Barlow manoeuvre and unilateral limited hip abduction were key to identifying cases at the six-to-eight-week mark.

The researchers said the current hip check was not supported by up to date evidence and it did not meet the accepted criteria for screening.

Writing in the British Journal of General Practice, they called for a rethink of the guidance including a potential additional test at three to four months when more cases may be picked up. 

Study author Mr Chris Talbot, consultant paediatric orthopaedic surgeon at Alder Hey Children’s Hospital said with the low sensitivity and positive predictive value they identified in the audit, there is a concern that cases of developmental dysplasia of the hip (DDH) would not be picked up and parents may also be falsely reassured.

'Despite this six to eight week assessment, in addition to risk factor screening and the neonatal examination, late presenting cases were still identified.

'It is recommended that there is a change in the UK screening programme to mitigate against the high number of late presenting DDH cases, such as an additional assessment at three to four months.'

Identifying DDH at three to four months would help identify children earlier and reduce the risk of them needing a corrective surgery, he added.

The researchers also called for better training for health professionals in primary care who would be carrying out hip checks.

Readers' comments (13)

  • GPs best placed again FFS.

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  • Any evidence that doing another check would yield any better outcomes? Surely if the test is the problem doing another one is not likely to significantly improve the results.

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  • I think an Orthopaedic Consultant should check all children at 3-4 months.

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  • Just ultrasound neonates

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  • Scan them all if you want 100% no misses. You get what you pay for. GP's scans gets bounced and are asked to do too much.

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  • If any one has to do it get the health visitors to do it......Will still miss cases with repeat clinical examination

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  • Of course I can!

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  • why are we doing any hip exams AT ALL if the pick up rate is so poor?

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  • I personally have found bigger infants much harder to examine as they are stronger and can resist examination. It is not logical to repeat a test with poor sensitivity in a group of children where sensitivity is decreased further.

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