Predicting developmental dysplasia of the hip in at-risk newborns
Abstract Background The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring. Therefore,...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-07-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12891-020-03454-4 |
| _version_ | 1818485718843916288 |
|---|---|
| author | Andreas Roposch Evangelia Protopapa Olivia Malaga-Shaw Yael Gelfer Paul Humphries Deborah Ridout John H. Wedge |
| author_facet | Andreas Roposch Evangelia Protopapa Olivia Malaga-Shaw Yael Gelfer Paul Humphries Deborah Ridout John H. Wedge |
| author_sort | Andreas Roposch |
| collection | DOAJ |
| description | Abstract Background The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring. Therefore, the study aim is to determine among at-risk newborns how to best predict developmental dysplasia of the hip (DDH) within 8 weeks post-partum. Methods Prospective cohort study in secondary care. Patient population included newborns at-risk for DDH – we assessed 13,276 consecutive newborns for the presence of DDH risk factors. Only newborns with at least one of the predefined risk factors and those showing an abnormal examination of the hip were enrolled (n = 2191). For the development of a risk prediction model we considered 9 candidate predictors and other variables readily available at childbirth. The main outcome measure was ultrasonography at a median age of 8 weeks using consensus diagnostic criteria; outcome assessors were blinded. Results The risk model includes four predictors: female sex (OR = 5.6; 95% CI: 2.9–10.9; P < 0.001); first degree family history of DDH (OR = 4.5; 95% CI: 2.3–9.0; P < 0.001), birthweight > 4000 g (OR = 1.6; 95% CI: 0.6–4.2; P = 0.34), and abnormal examination of hip (OR = 58.8; 95% CI: 31.9, 108.5; P < 0.001). This model demonstrated excellent discrimination (C statistic = 0.9) and calibration of observed and predicted risk (P = 0.35). A model without the variable ‘hip examination’ demonstrated similar performance. Conclusion The risk model quantifies absolute risk of DDH within 8 weeks postpartum in at-risk newborns. Based on clinical variables readily available at the point of childbirth, the model will enhance parental counselling and could serve as the basis for real time decisions prior to discharge from maternity wards. |
| first_indexed | 2024-12-10T16:12:40Z |
| format | Article |
| id | doaj.art-7e40519e3cca43b2a998b5d1561762f5 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-10T16:12:40Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-7e40519e3cca43b2a998b5d1561762f52022-12-22T01:42:03ZengBMCBMC Musculoskeletal Disorders1471-24742020-07-012111810.1186/s12891-020-03454-4Predicting developmental dysplasia of the hip in at-risk newbornsAndreas Roposch0Evangelia Protopapa1Olivia Malaga-Shaw2Yael Gelfer3Paul Humphries4Deborah Ridout5John H. Wedge6Institute of Child Health, University College LondonInstitute of Child Health, University College LondonRoyal Free Hospital NHS TrustDepartment of Orthopaedic Surgery, St George’s HospitalDepartment of Diagnostic Imaging, University College HospitalInstitute of Child Health, University College LondonDepartment of Surgery, University of TorontoAbstract Background The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring. Therefore, the study aim is to determine among at-risk newborns how to best predict developmental dysplasia of the hip (DDH) within 8 weeks post-partum. Methods Prospective cohort study in secondary care. Patient population included newborns at-risk for DDH – we assessed 13,276 consecutive newborns for the presence of DDH risk factors. Only newborns with at least one of the predefined risk factors and those showing an abnormal examination of the hip were enrolled (n = 2191). For the development of a risk prediction model we considered 9 candidate predictors and other variables readily available at childbirth. The main outcome measure was ultrasonography at a median age of 8 weeks using consensus diagnostic criteria; outcome assessors were blinded. Results The risk model includes four predictors: female sex (OR = 5.6; 95% CI: 2.9–10.9; P < 0.001); first degree family history of DDH (OR = 4.5; 95% CI: 2.3–9.0; P < 0.001), birthweight > 4000 g (OR = 1.6; 95% CI: 0.6–4.2; P = 0.34), and abnormal examination of hip (OR = 58.8; 95% CI: 31.9, 108.5; P < 0.001). This model demonstrated excellent discrimination (C statistic = 0.9) and calibration of observed and predicted risk (P = 0.35). A model without the variable ‘hip examination’ demonstrated similar performance. Conclusion The risk model quantifies absolute risk of DDH within 8 weeks postpartum in at-risk newborns. Based on clinical variables readily available at the point of childbirth, the model will enhance parental counselling and could serve as the basis for real time decisions prior to discharge from maternity wards.http://link.springer.com/article/10.1186/s12891-020-03454-4Developmental dysplasia of the hipRisk factorsNew bornPrediction model |
| spellingShingle | Andreas Roposch Evangelia Protopapa Olivia Malaga-Shaw Yael Gelfer Paul Humphries Deborah Ridout John H. Wedge Predicting developmental dysplasia of the hip in at-risk newborns BMC Musculoskeletal Disorders Developmental dysplasia of the hip Risk factors New born Prediction model |
| title | Predicting developmental dysplasia of the hip in at-risk newborns |
| title_full | Predicting developmental dysplasia of the hip in at-risk newborns |
| title_fullStr | Predicting developmental dysplasia of the hip in at-risk newborns |
| title_full_unstemmed | Predicting developmental dysplasia of the hip in at-risk newborns |
| title_short | Predicting developmental dysplasia of the hip in at-risk newborns |
| title_sort | predicting developmental dysplasia of the hip in at risk newborns |
| topic | Developmental dysplasia of the hip Risk factors New born Prediction model |
| url | http://link.springer.com/article/10.1186/s12891-020-03454-4 |
| work_keys_str_mv | AT andreasroposch predictingdevelopmentaldysplasiaofthehipinatrisknewborns AT evangeliaprotopapa predictingdevelopmentaldysplasiaofthehipinatrisknewborns AT oliviamalagashaw predictingdevelopmentaldysplasiaofthehipinatrisknewborns AT yaelgelfer predictingdevelopmentaldysplasiaofthehipinatrisknewborns AT paulhumphries predictingdevelopmentaldysplasiaofthehipinatrisknewborns AT deborahridout predictingdevelopmentaldysplasiaofthehipinatrisknewborns AT johnhwedge predictingdevelopmentaldysplasiaofthehipinatrisknewborns |