Section for Pediatric Radiology, Department of Radiology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Pediatr Radiol. 2023 Sep;53(10):1977-1988. doi: 10.1007/s00247-023-05666-x. Epub 2023 Apr 26.
Different screening strategies for developmental dysplasia of the hip (DDH) exist. Despite screening efforts, cases of late presentation continue to occur, often necessitating surgery. This systematic review and meta-analysis assess the effect of newborn selective ultrasound screening for DDH on the incidence of late presentation in infants and children, compared to a universal ultrasound strategy. A systematic search across Medline and EMBASE databases was performed between January 1950 and February 2021. A consensus-based evaluation of abstracts led to retrieval of relevant full text, original articles or systematic reviews in English only. These were assessed according to agreed eligibility criteria, and their reference lists were reviewed to identify additional eligible publications. Following final consensus on included publications, data was extracted, analysed and reported as per PRISMA and Prospero (CRD42021241957) guidelines. The 16 eligible studies consisted of 2 randomised controlled trials and 14 cohort studies, published between 1989 and 2014, with a total of 511,403 participants. In total, 121,470 (23.8%) received a neonatal hip ultrasound, of whom 58,086 and 63,384 were part of a selective or a universal ultrasound screening strategy, respectively. The difference in the proportion of late presentation between the universal and selective strategies was 0.0904 per 1,000 (P = 0.047). The time effect, i.e. the difference between early and late presentation defined respectively, as less than and more than 3 months of age, regardless of screening strategy, was not significant (P = 0.272). Although there was variability in study design and reporting, the quality of the evidence, based on the critical appraisal skills programme appraisal tools, was generally good. Compared to universal ultrasound screening for DDH, selective screening resulted in a slightly higher rate of late presentation. Uniformity in design and reporting of DDH studies and a cost-effectiveness analysis are needed.
不同的发育性髋关节发育不良（DDH）筛查策略存在。尽管进行了筛查，但仍有迟发病例发生，常需手术治疗。本系统评价和荟萃分析评估了新生儿选择性髋关节超声筛查与普遍超声策略相比，对婴儿和儿童迟发病例发生率的影响。在 1950 年 1 月至 2021 年 2 月期间，在 Medline 和 EMBASE 数据库中进行了系统检索。对摘要进行基于共识的评估，以检索相关的全文、原始文章或仅英文的系统评价。根据商定的入选标准对这些文章进行评估，并对其参考文献进行审查，以确定其他合格的出版物。在对入选文献达成最终共识后，按照 PRISMA 和 Prospero（CRD42021241957）指南提取、分析和报告数据。16 项合格研究包括 2 项随机对照试验和 14 项队列研究，发表于 1989 年至 2014 年之间，共有 511,403 名参与者。共有 121,470 名（23.8%）接受了新生儿髋关节超声检查，其中 58,086 名和 63,384 名分别为选择性或普遍超声筛查策略的一部分。普遍和选择性策略之间迟发病例比例的差异为每 1,000 例 0.0904（P=0.047）。时间效应，即分别定义为小于和大于 3 个月的早发和迟发病例之间的差异，与筛查策略无关，差异无统计学意义（P=0.272）。尽管研究设计和报告存在差异，但基于关键评估技能计划评估工具，证据质量总体良好。与 DDH 的普遍超声筛查相比，选择性筛查导致迟发病例的发生率略高。需要统一 DDH 研究的设计和报告，并进行成本效益分析。
