Do Doctors Agree on the Diagnosis of DDH?

Do Doctors Agree on the Diagnosis of DDH?

Estimates of the frequency of DDH vary when reported by different research studies. Also, there are differences in frequency of treatment of DDH. Some of this variation may be explained by differences in opinions about diagnosis of dysplasia and diagnosis of severity of DDH.

Roposch et al and their team from London, UK, sought to determine

  1. the consistency with which pediatric orthopaedic surgeons apply diagnostic criteria for DDH
  2. whether there were geographic differences in how the diagnostic criteria were used by surgeons

One hundred ninety-seven of 220 members of the European Paediatric Orthopaedic Society and 100 of 148 members of the British Society of Children’s Orthopaedic Surgery treating children with DDH participated in this cross-sectional study across 35 countries (15 regions). Each rated 37 items that specialists previously had identified as the most important features associated with DDH in early infancy.

Poor consistency among surgeons was found in rating the 37 diagnostic criteria. Surgeons in particular regions appeared to have a concept of DDH diagnosis that distinguished them from specialists of other regions; consistency in eight regions was greater than consistency among all 15 regions.

Comments: The consistency of specialists in rating diagnostic criteria for DDH was lower than expected, and there was considerable geographic variation in terms of how specialists assigned importance of the diagnostic criteria; these findings are somewhat disappointing, given the frequency with which this condition is diagnosed. These inconsistencies could partly explain the widely differing frequency estimates and management standards of DDH.

The IHDI is discussing this study as a group and working to establish criteria for diagnosis that are based on clinical practices from multiple centers. This study points out that need for clarity.

Roposch A, Liu LQ, Protopapa E. Variations in the Use of Diagnostic Criteria for Developmental Dysplasia of the Hip. Clin Orthop Relat Res. 2013 Mar 21. [Epub ahead of print]