Enhanced detection services for developmental dysplasia of the hip in Scottish children, 1997-2013

McAllister, D. A. , Morling, J. R., Fischbacher, C. M., Reidy, M., Murray, A. and Wood, R. (2018) Enhanced detection services for developmental dysplasia of the hip in Scottish children, 1997-2013. Archives of Disease in Childhood, 103(11), pp. 1021-1026. (doi: 10.1136/archdischild-2017-314354) (PMID:29436408) (PMCID:PMC6225802)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McAllister, Professor David
Authors: McAllister, D. A., Morling, J. R., Fischbacher, C. M., Reidy, M., Murray, A., and Wood, R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:Archives of Disease in Childhood
Publisher:BMJ Publishing Group
ISSN:0003-9888
ISSN (Online):1468-2044
Published Online:07 February 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Archives of Disease in Childhood 103(11): 1021-1026
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
754451Combining efficacy estimates from clinical trials with the natural history obtained from large routine healthcare databases to determine net overall treatment benefitsDavid McAllisterWellcome Trust (WELLCOTR)201492/Z/16/ZIHW - PUBLIC HEALTH