Figure 1. Analytic Framework. Screening for Developmental Dysplasia of the Hip (DDH)

[D] Select for Text Description.

Key Questions: Screening for Developmental Dysplasia of the Hip (DDH)

• Arrow 1: Does screening for DDH lead to improved outcomes (including reduced need for surgery and improved functional outcomes such as: gait, physical functioning, activity level, peer relations, family relations, school and occupational performance)?
• Arrow 2: Can infants 0-6 months at high risk for DDH be identified, and does this group warrant a different approach to screening than children 0-6 months at average risk?
• Arrow 3: Does screening for DDH lead to early identification of children with DDH, including dislocated hips and subluxable hips?
  1. What is the accuracy of clinical examination and ultrasound?
  2. How does the age of the child affect screening parameters?
  3. How does the educational level and training of the screener impact screening?
• Arrow 4: What are the adverse effects of screening?
• Arrow 5: Does early diagnosis of DDH lead to early intervention, and does early intervention reduce the need for surgery or improve functional outcomes?
  1. Is the likelihood of surgical intervention reduced in children diagnosed at an earlier age?
• Arrow 6: What are the adverse effects of early diagnosis and/or intervention?
• Key question 7 (no arrow): What cost-effectiveness issues apply to screening for DDH?

*Screening examination (Barlow/Ortolani, Assymetry, ROM) and Radiographic evaluation (ultrasound, x-ray)

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