IS NOTHING SACRED?

Few parts of the physical examination are as sacred as the Barlow and Ortolani procedures that are used to detect developmental dysplasia of the hip (DDH). The United States Preventive Services Task Force (USPSTF), the US equivalent of NICE, recently released recommendations regarding screening for DDH (http://www.ahrq.gov/clinic/uspstf/uspshipd.htm). Their conclusion – there is insufficient evidence to “recommend routine screening for developmental dysplasia of the hip in infants as a means to prevent adverse outcomes.” The Task Force makes the following important points:

• Screening leads to earlier detection of DDH, but 60% to 80% of hips that are identified as abnormal by physical examination will normalise spontaneously within 2 to 8 weeks.

• Insufficient evidence exists to determine whether surgical or nonsurgical interventions are effective.

• Harm is possible, false-positive screens can cause parental stress, lead to additional costly testing, and repeated examination of the hip may …