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


METHODS
Systematic review.


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


METHODS
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.
Woolacott
Nerys F
NF
Centre for Reviews and Dissemination, University of York, York YO10 5DD. nw11@york.ac.uk <nw11@york.ac.uk>
Puhan
Milo A
MA
Steurer
Johann
J
Kleijnen
Jos
J
D002986:Clinical Trials as Topic; D042241:Early Diagnosis; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000379:methods* / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D014463:Ultrasonography