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The Availability of Ultrasound for Infants with D.D.H In Pennsylvania In 2012

Sunday, October 21, 2012: 8:07 AM
Melrose (Hilton Riverside)
Shane Lavin, Orthiopaedics, Penn State College of Medicine, Hershey, PA and William Hennrikus, MD, Orthopaedics, Penn State College of Medicine, Hershey, PA

Purpose   Careful clinical examination of all newborn babies supplemented by ultrasound exam (US) for select infants is the most common method for diagnosing developmental dysplasia of the hip (DDH) today.   US is also often used to monitor hip position and acetabular development in infants undergoing harness treatment up to the age of about 4 months.  Early diagnosis and treatment of DDH presumably reduces morbidity such as gait anomalies, pain, and arthritis. The literature often assumes that US is universally available for the diagnosis and treatment of DDH.  The purpose of this paper is to determine the availability of US for examining infants for DDH in the state of Pennsylvania (PA).

Methods   The study was approved by the College of Medicine’s IRB.  A questionnaire designed to evaluate the availability of US for DDH was mailed to all members of the PA chapter of the AAP and to all physician directors of hospital radiology departments in the state of PA.   

Results  Questionnaires were mailed to 744 AAP member pediatricians and to 100 to radiologists.  110 pediatricians (15%) and 24 radiologists (24%) returned a completed questionnaire.  76% of pediatricians that responded had access at a local hospital to US for infants with DDH.  Of those with access to US, 86% were satisfied with the US service that was available and 14 % were not satisfied. Reasons for dissatisfaction included: lack of experience, lack of training, operator subjectiveness, questionable technical skills, lack of a pediatric radiologist, and lack of US technologist.  34% of pediatricians did not have local access to ultrasound.  When US was not available locally, 95% of pediatricians sent their patient to another hospital for the US study at a distance of up to 130 miles. Five percent of pediatricians utilized radiographs when US was not available.  67% of the radiology directors responded that their department provided US for infants with DDH.  94% were satisfied with their service.  34% of radiology directors did not offer US services.  In cases in which US was not offered, 71% of infants were referred to another hospital with US services; in 14 % of cases radiography was utilized,  15 % did not respond to this question. 

Conclusion  US for DDH is not always available or obtained conveniently in the state of Pennsylvania. Pediatricians were less satisfied than radiologists with the availability of US services.  Infants travel up to 130 miles to obtain US services.  Radiographs are utilized in some rural areas of the state when US is not available. This study evaluates the availability of US and not the accuracy or reproducibility. However, collaboration of pediatric, orthopaedic, and radiologic organizations is recommended to establish centers of excellence for standardized pediatric hip US studies in multiple locations in each state.