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• W2135594441 abstract "Annabelle Chan and colleagues (Oct 30, p 1514)1Chan A Cundy P Foster B Keane R Byron-Scott R Late diagnosis of congenital dislocation of the hip and presence of a screening programme: South Australian population-based study.Lancet. 1999; 354: 1514-1517Summary Full Text Full Text PDF PubMed Scopus (51) Google Scholar report the success of the Australian screening programme for congenital dislocation of the hip (CDH), and contrast this success with the findings of the Medical Research Council Working Party2Godward S Dezateux C Surgery for congenital dislocation of the hip in the UK as a measure of outcome of screening.Lancet. 1998; 351: 1149-1152Summary Full Text Full Text PDF PubMed Scopus (100) Google Scholar on the UK programme. The aim of a CDH screening programme is to detect and treat abnormal hips at an early stage to ensure normal hip development and function during childhood and adolescent growth. The success of a screening programme cannot be measured directly because there is no confirmatory diagnostic test for CDH; treatment is usually started before the disorder becomes manifest, and there is a lack of population-based data on hip morphology and function in screened or unscreened populations. Assessment is thus by inference from the incidence of early treatment and the incidence of an operative procedure, and the relation of these to the background prevalence of CDH. The Australian and the UK screening programmes used routine hospital inpatient data to identify children under 5 years receiving a first operative procedure for CDH. However, the UK study undertaken in a larger population included active case reporting through a national surveillance scheme among orthopaedic surgeons. This scheme showed that routine data would have identified 77% of eligible cases. If this finding were applied to the Australian population the incidence of an operative procedure would be 0·61 per 1000 livebirths (95% CI 0·47–0·75) rather than 0·46 (95% CI 0·34–0·59) as reported. This revised figure is consistent with the findings of the UK study in which the incidence of an operative procedure was estimated to be 0·78 per 1000 livebirths (95% CI 0·72–0·84). The unadjusted estimates of the incidence of an operative procedure in the two studies are similar. None of the children identified through routine data in the UK study were born outside the UK, whereas 19% (16) of children were excluded from the Australian study because they had been born outside Southern Australia, and conversely, some children born in Southern Australia may have been treated elsewhere. The type of surgery must be accounted for in the assessment of programme effectiveness.3Feldman D How to avoid missing congenital dislocation of the hip.Lancet. 1999; 354: 1490Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar In the Australian study only 16% (nine) of children had a minor procedure compared with 47% (59) of the UK children identified through routine data, whereas nearly twice as many Australian children as UK children had a major procedure involving an open reduction or osteotomy (33% vs 17%). Australian children were more likely to receive complex surgery than UK children even though they were diagnosed at a younger age. Comparison of the Australian and UK studies show the complexity of assessment of a screening programme for CDH.3Feldman D How to avoid missing congenital dislocation of the hip.Lancet. 1999; 354: 1490Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar Inferences are hampered by a lack of knowledge of background prevalence, variations in the threshold for treatment, and the vulnerability of estimates of incidence to even low levels of case underascertainment. Screening for congenital dislocation of the hipAuthor's reply Full-Text PDF" @default.
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• W2135594441 title "Screening for congenital dislocation of the hip" @default.
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• W2135594441 doi "https://doi.org/10.1016/s0140-6736(05)72104-8" @default.
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