Milks Kathryn S, Mesi Erin L, Whitaker Amanda T, Ruess Lynne
Fromt the Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio.
Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio.
Pediatr Qual Saf. 2021 Dec 15;6(6):e485. doi: 10.1097/pq9.0000000000000485. eCollection 2021 Nov-Dec.
Detection of hip migration in children with cerebral palsy (CP) through radiographic surveillance can prevent dislocations. Migration Percentage (MP) is the accepted method for quantifying hip subluxation in CP on pelvis x-ray but was not being reported at our institution. Our objective was to improve care for children with CP by standardizing radiographic techniques and reporting radiographs obtained as part of a hip surveillance program.
A baseline retrospective review of CP surveillance pelvis x-ray reports was performed. We then educated radiologists and technologists, standardized imaging techniques, and required structured radiology reporting to include MP measurement and dislocation risk categories. We tracked compliance with the reporting template for 10 months. Images and reports were also assessed for quality and accuracy by an orthopedic surgeon.
Baseline period reports showed no consistency. In total, 449 children with CP (mean age: 7.3 years ± 4.2) had a surveillance pelvis radiograph during the postintervention study period (May 2019-February 2020). An estimated 90% reporting compliance was achieved and sustained by 5 months. Eight (89%) of the children with high-risk hips were newly diagnosed during our study period; all had a progressive increase in MP from prior examinations. All clinicians surveyed agreed that the standardized reports, including MP, were helpful to their practice.
Using evidence-based process measures and quality improvement methodology, we standardized hip surveillance for children with CP. Radiology reports that include MP and risk category for hip dislocation enable clear communication for referrals across specialties and early detection and treatment for better outcomes.
通过影像学监测来检测脑瘫（CP）患儿的髋关节移位情况可预防脱位。移位百分比（MP）是用于量化CP患儿骨盆X线片上髋关节半脱位的公认方法，但在我们机构此前并未报告该指标。我们的目标是通过规范影像学技术并报告作为髋关节监测计划一部分所获得的X线片，来改善对CP患儿的护理。
对CP监测骨盆X线片报告进行基线回顾性分析。然后，我们对放射科医生和技术人员进行培训，规范成像技术，并要求结构化的放射学报告包括MP测量和脱位风险分类。我们跟踪了10个月内对报告模板的依从情况。一名骨科医生还对图像和报告的质量及准确性进行了评估。
基线期报告显示缺乏一致性。在干预后研究期间（2019年5月至2020年2月），共有449例CP患儿（平均年龄：7.3岁±4.2岁）接受了骨盆监测X线检查。5个月时实现并维持了约90%的报告依从率。在我们的研究期间，8例（89%）髋关节高危患儿被新诊断出来；所有患儿的MP较之前检查均呈进行性增加。所有接受调查的临床医生均认为，包括MP在内的标准化报告对他们的临床工作有帮助。
通过采用循证流程指标和质量改进方法，我们规范了CP患儿的髋关节监测。包含MP和髋关节脱位风险分类的放射学报告有助于各专科之间进行清晰的转诊沟通，并实现早期检测和治疗，从而获得更好的治疗效果。
