title: Pilot evaluation of anterior dynamic ultrasound screening for developmental dysplasia of the hip in an Australian regional hospital.
abstract: BACKGROUND
  Developmental Dysplasia of the Hip (DDH) is the most common notifiable musculoskeletal birth defect in South Australia (SA). Despite routine screening by physical examination of the hips in the neonatal period and at 6 weeks of age, the risk of late diagnosis is increased in rural areas. It is assumed this is due to the examining doctors' reduced clinical expertise. Introducing Anterior Dynamic Ultrasound (ADUS) has reduced the late detection rates in Sweden to almost zero, and may benefit Australian infants in rural areas if routine screening was introduced. This study reports on a small implementation pilot in a SA regional hospital where volunteer postnatal mothers consented to their babies having ADUS examinations.
  
  
  METHODS
  The pilot was evaluated by collecting results of physical examination, ADUS, and surveying parental impressions of the screening test.
  
  
  RESULTS
  Hips of 86 infants underwent ADUS during the implementation pilot. Parents' perceptions were mainly very positive and indicated ADUS was an accessible and acceptable screening test. Of the hips scanned, three were found to have maximum movement of the femoral head of >3 mm and were deemed to demonstrate increased laxity. Four hips described as loose or mobile on clinical examination were found to be within normal limits of maximum mobility on ADUS.
  
  
  CONCLUSIONS
  This study has demonstrated that a larger scale implementation project would be feasible in regional Australia, and would enable researchers to better understand how to reduce the late diagnosis rate of DDH in rural areas.
authors.affiliation: 1 Stop Paediatric Services, Mount Gambier, South Australia, Australia. sue@auecharlton.com.au
authors.forename: S
authors.initials: S
authors.lastname: Charlton
authors.forename: L
authors.initials: L
authors.lastname: Muir
authors.forename: T C
authors.initials: TC
authors.lastname: Skinner
authors.forename: L
authors.initials: L
authors.lastname: Walters
mesh_terms: D001315:Australia; D001848:Bone Diseases, Developmental / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000523:psychology; D057210:Delayed Diagnosis / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000523:psychology; D006801:Humans; D007231:Infant, Newborn; D007593:Joint Instability / Q000151:congenital / Q000175:diagnosis / Q000000981:diagnostic imaging; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009038:Motion; D058748:Pain Perception; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D010549:Personal Satisfaction; D010808:Physical Examination / Q000379:methods; D010865:Pilot Projects; D015397:Program Evaluation; D012041:Regional Medical Programs; D012424:Rural Population; D013021:South Australia; D013315:Stress, Psychological; D013997:Time Factors; D014463:Ultrasonography