Newborn Hip Screenings at 4 to 8 Weeks Are Optimal in Predicting Referral and Treatment Outcomes: A Retrospective Review

Optimal DDH screening timing and whether adding risk profiles could aid in detecting treatment outcome were investigated. Risk factors were employed to supplement ultrasound findings in flagging cases for follow-up. Initial screening results and harness treatment outcomes concordance were compared at different screening ages and screening protocols. Using clinical decision to supplement ultrasound screening allowed to accurately flag all 12 DDH treated cases upon initial visit. Clinical decision correctly identified cases that would have otherwise been missed (n = 2). However, doing so increased the rate of false positive cases at all time points of initial screening. Initial screens were more accurate for predicting treatment outcomes when using ultrasound only if done after 28 days [≤28 days (88.1%) vs. 29 - 56 days (98.5%), OR = 7.16, p < 0.001] or ultrasound with clinical decision [≤28 days (86.4%) vs. 29 - 56 days (95.7%), OR = 3.00, p < 0.001]. In contrast, screening after 56 days failed to marginally improve accuracy compared to screens done between 29 - 56 days, regardless of the screening protocol employed. Two important trade-offs emerged. First, when choosing timing of initial screening, optimal accuracy and harness treatment schedule should both be considered. Second, when considering whether to use a more conservative risk profile to supplement ultrasound findings, treatment accuracy and the ability to efficiently detect cases requiring harness treatment should both be considered. We provide evidence for performing an initial DDH ultrasound screen between 4 and 8 weeks (29 - 56 days), while employing clinical decision to aid in determining cases that require further follow-up evaluation.