ACR issues appropriateness criteria for pediatric hip dysplasia

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Although physicians should perform early screening of children for developmental dysplasia of the hip (DDH), diagnostic imaging is recommended only for those children at high risk of DDH, according to appropriateness criteria from the American College of Radiology (ACR).

These findings are among the appropriateness criteria on DDH—formerly known as dislocation of the hip--issued in the Journal of the American College of Radiology.

Early screening of the condition is crucial because late diagnosis of the condition could result in increased surgical intervention and the possible development of debilitating generative hip disease, reported the panel, headed by pediatric radiologist Boaz K. Karmazyn, MD, at Indiana University Medical Center in Indianapolis.

DDH affects 1.5 out of every 1,000 caucasian Americans. It less frequently affects African-Americans, is four to eight times more common in females and more common in patients with family histories of DDH, as well as firstborns, large infants and infants with histories of oligohydramnios.

According to the panel, clinical evaluation of the hips for DDH should be performed at each well-baby visit.  As far as the utilization of diagnostic imaging screening of children for DDH, the panel said the routine use of ultrasound to screen infants “cannot be recommended.” They cited two randomized trials that found no significant difference in the rates of detection of late DDH in infants who were screened with ultrasound compared with those screened with a series of high-quality physical exams.

For children with a high risk for DDH, ultrasound and radiographic imaging should be used, even with normal results from physical examinations, according to the criteria.

For the complete report, see the August issue of the Journal of the American College of Radiology.