You are here

Article Text

Article menu

Download PDFPDF

Original article
Enhanced detection services for developmental dysplasia of the hip in Scottish children, 1997–2013
  1. David, A McAllister1,2,
  2. Joanne, R Morling3,
  3. Colin, M Fischbacher2,
  4. Mike Reidy4,
  5. Alastair Murray5,
  6. Rachael Wood2,6
  1. 1 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  2. 2 NHS Information Services Division, NHS National Services Scotland, Edinburgh, UK
  3. 3 Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
  4. 4 Orthopaedics Department, NHS Tayside, Edinburgh, UK
  5. 5 Royal Hospital for Sick Children, NHS Lothian, Edinburgh, UK
  6. 6 Child Life and Health, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr David and A McAllister, University of Glasgow, Institute of Health and Wellbeing, Glasgow G12 8RZ, UK; david.mcallister{at}glasgow.ac.uk

Abstract

Background Developmental dysplasia of the hip (DDH) remains common. If detected early, DDH can usually be corrected with conservative management. Late presentations often require surgery and have worse outcomes.

Objective We estimated the risk of undergoing surgery for DDH by age 3 years before and after the introduction of enhanced DDH detection services.

Design Retrospective cohort study.

Setting Scotland, 1997/98–2010/11.

Patients All children.

Methods Using routinely collected national hospital discharge records, we examined rates of first surgery for DDH by age 3 by March 2014. Using a difference in difference analysis, we compared rates in two areas of Scotland before (to April 2002) and after (from April 2005) implementation of enhanced DDH detection services to those seen in the rest of Scotland.

Results For children born in the study period, the risk of first surgery for DDH by age 3 was 1.18 (95% CI 1.11 to 1.26) per 1000 live births (918/777 375).

Prior to April 2002, the risk of surgery was 1.13 (95% CI 0.88 to 1.42) and 1.31 (95% CI 1.16 to 1.46) per 1000 live births in the intervention and non-intervention areas, respectively. In the intervention areas, from April 2005, this risk halved (RR 0.47; 95% CI 0.32 to 0.68). The risk remained unchanged in other areas (RR 1.01; 95% CI 0.86 to 1.18). The ratio for the difference in change of risk was 0.46 (95% CI 0.31 to 0.70).

Conclusions The implementation of enhanced DDH detection services can produce substantial reductions in the number of children having surgical correction for DDH.

  • paediatric surgery
  • screening

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/archdischild-2017-314354

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors DM and JM contributed to study design, analysed and interpreted the data, drafted and revised the manuscript. MR revised the manuscript. CF, AM and RW designed the study, interpreted the data and revised the manuscript.

    • Funding DM is funded via an Intermediate Clinical Fellowship (and Beit Fellowship) from the Wellcome Trust (201492/Z/16/Z). JM is funded via a Clinician Scientist Fellowship from the Medical Research Council. Neither sponsor had any role in the design, analysis or reporting of this work.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data can be obtained from the Information Services Division, NHS National Services Scotland via established data access policies. Contact ISD’s Electronic Data Research and Innovation Service (http://www.isdscotland.org/Products-and-Services/eDRIS/).

    Linked Articles

    • Editorial
      Hip hip: no hurray
      David M Hall David Sowden
      Archives of Disease in Childhood 2018; 103 1006-1007 Published Online First: 16 Apr 2018. doi: 10.1136/archdischild-2018-314813