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GP checks ineffective in identifying developmental dysplasia of the hip

The NHS Newborn and Infant Physical Examination (NIPE) programme’s GP check at 6-8 weeks is ineffective in identifying developmental dysplasia of the hip (DDH), the authors of a new study say.

The longitudinal observational study including all live births in Dundee in the 5 years following 2006. Early presentation was defined as diagnosis within 14 weeks of birth and late presentation after 14 weeks. Treatment records for early and late DDH as well as referrals for ultrasound following examination at 6-8 weeks were analysed.

Among the 23,112 included infants, there were 141 confirmed cases of DDH. A total of 400 referrals for ultrasound were received following examination at 6-8 weeks; 6 of these had a positive finding of DDH. Twenty-seven patients presented after 14 weeks. Twenty-five of these patients had attended the examination at 6-8 weeks and no abnormality had been identified.

The sensitivity of the 6-8 week GP check for identifying DDH was only 19.4%. Its specificity was 98% and it had a positive predictive value of 1.5%.

“For many years the check at 6-8 weeks has been thought of as a means to identify those children not identified as neonates; however, we found that 4 out of 5 children with DDH were not identified by the check at 6-8 weeks. Unfortunately, we conclude that the presumed safety net of the examination in its current form is not reliable,” the study authors said.


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