title: Standardized diagnostic criteria for developmental dysplasia of the hip in early infancy.
abstract: BACKGROUND
  Clinicians use various criteria to diagnose developmental dysplasia of the hip (DDH) in early infancy, but the importance of these various criteria for a definite diagnosis is controversial. The lack of uniform, widely agreed-on diagnostic criteria for DDH in patients in this age group may result in a delay in diagnosis of some patients.
  
  
  OBJECTIVE
  Our purpose was to establish a consensus among pediatric orthopaedic surgeons worldwide regarding the most relevant criteria for diagnosis of DDH in infants younger than 9 weeks.
  
  
  METHODS
  We identified 212 potential criteria relevant for diagnosing DDH in infants by surveying 467 professionals. We used the Delphi technique to reach a consensus regarding the most important criteria. We then sent the survey to 261 orthopaedic surgeons from 34 countries.
  
  
  RESULTS
  The response rate was 75%. Thirty-seven items were identified by surgeons as most relevant to diagnose DDH in patients in this age group. Of these, 10 of 37 (27%) related to patient characteristics and history, 13 of 37 (35%) to clinical examination, 11 of 37 (30%) to ultrasound, and three of 37 (8%) to radiography. A Cronbach alpha of 0.9 for both iterations suggested consensus among the panelists.
  
  
  CONCLUSIONS
  We established a consensus regarding the most relevant criteria for the diagnosis of DDH in early infancy and established their relative importance on an international basis. The highest ranked clinical criteria included the Ortolani/Barlow test, asymmetry in abduction of 20° or greater, breech presentation, leg-length discrepancy, and first-degree relative treated for DDH.
  
  
  METHODS
  Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. a.roposch@ich.ucl.ac.uk
authors.forename: Andreas
authors.initials: A
authors.lastname: Roposch
authors.forename: Liang Q
authors.initials: LQ
authors.lastname: Liu
authors.forename: Fritz
authors.initials: F
authors.lastname: Hefti
authors.forename: Nicholas M P
authors.initials: NM
authors.lastname: Clarke
authors.forename: John H
authors.initials: JH
authors.lastname: Wedge
mesh_terms: D003697:Delphi Technique; D005260:Female; D019538:Health Care Surveys; D006618:Hip Dislocation, Congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D014463:Ultrasonography