Godward, Sara; (1997) An epidemiological evaluation of the UK screening programme for congenital dislocation of the hip. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

In the United Kingdom (UK), a policy of universal clinical screening was formally adopted in 1969. This screening programme was established to detect infants with hip instability so that early conservative treatment could be applied, and congenital dislocation of the hip (CDH) averted. However, the effectiveness of clinical screening has not been evaluated in a randomised trial, and is controversial. National data on effectiveness are lacking and individual centres have reported conflicting results. Although ultrasound imaging of the newborn hip has been adopted as a universal primary screening test in some European countries, enthusiasm for its introduction in the UK has been tempered by the consequent fourfold increase in the number of children identified as requiring early treatment. In this thesis the scientific basis of the current UK screening policy for CDH and alternative strategies is critically appraised, and a national study undertaken to evaluate the existing programme presented. Current screening and management practices were characterised from data obtained from a national postal survey of all maternity units in the UK and Irish Republic. Paediatricians were asked to report children in whom they initiated abduction splinting through the British Paediatric Surveillance Scheme, which operates through an active surveillance scheme. Children in whom abduction splinting was initiated or who received a first operative procedure for CDH were reported through a similar scheme established among orthopaedic surgeons. Reported cases of a first operative procedure were validated with Hospital Episode System data for 18% of births. The extent of under ascertainment of cases was estimated by capture-recapture analysis. The prevalence of a first operative procedure for CDH was 0.78 per 1000 live births (95% confidence interval (CI): 0.72, 0.84) and of conservative treatment, 1.6 per 1000 live births (95% CI: 1.4, 1.7). More than two-thirds of the children who received a first operative procedure had not been detected by screening, while conservative treatment had been unsuccessful in a fifth. In the last decade there has been a fivefold increase in the use of ultrasound imaging, which in 1994, was used in 69% of maternity units as a secondary screening test for infants at high risk of CDH or with clinical hip instability. In this first national study, the prevalence of surgery was found to be similar to the prevalence of CDH before screening was introduced, although twice as many infants received conservative treatment than previously were affected.

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