I Miras Aguilar, M Pangua Gómez, L Fidalgo Marrón, E Castaño Andreu, C Llorente Ruiz, G Galicia Poblet, A Aldea Romero, P Álvarez Estrada, A Ortigado Matamala
{"title":"髋关节发育不良：与诊断相关的因素和选择性筛查的特点。","authors":"I Miras Aguilar, M Pangua Gómez, L Fidalgo Marrón, E Castaño Andreu, C Llorente Ruiz, G Galicia Poblet, A Aldea Romero, P Álvarez Estrada, A Ortigado Matamala","doi":"10.1007/s43465-024-01315-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Backgrounds: </strong>Breech presentation, family history, and physical examination are the most recognized risk factors for DDH, which form the basis of selective screening. However, this approach can lead to late diagnosis, invasive treatments, and complications. This study analyzes the effectiveness of selective screening and identifies additional factors related to DDH.</p><p><strong>Methods: </strong>A retrospective case-control analytical study is designed, including children who are assessed through screening between 2012 and 2019. The variables examined include clinical and gestational characteristics, as well as examination findings. Descriptive analysis is conducted, followed by univariate analysis using Chi-squared, Fisher's exact, or Student's <i>T</i> tests. For multivariate analysis, the \"all set\" user command is employed. Sensitivity, specificity, and ROC curve are calculated, with a significance level set at <i>p</i> < 0.05. StataIC 16 and SAS System 9.4 are used.</p><p><strong>Results: </strong>762 children are included in the study, of which 33 are diagnosis with DDH. A total of 8,191 models are developed to predict DDH. The best logistic regression model identified the following independent predictors of dysplasia: newborn weight (OR 1.2, 95% CI 1.1-1.4), female sex (OR 3.9; 95% CI 1.4-10.9), cephalic presentation (OR 17.8; 95% CI 2.3-137.3), primiparity (OR 2.6; 95% CI 1.1-5.7), and examination (OR 149.6; 95% CI 18-1121.4). This model correctly classifies 83.6% patients (ROC curve 0.86). In selective screening, examination is the only identified risk factor for DDH, yet its sensitivity does not exceed 10%.</p><p><strong>Conclusions: </strong>This study proposed a total of 8191 models to predict DDH. The identified predictors include female sex, birth weight, cephalic presentation, and primiparity. While physical examination is the primary risk factor, it detects only decentred hips. The low sensitivity of selective screening raises questions about whether it remains the most appropriate method for identifying DDH in current practice.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"164-172"},"PeriodicalIF":1.1000,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775354/pdf/","citationCount":"0","resultStr":"{\"title\":\"Developmental Dysplasia of the Hip: Factors Related to the Diagnosis and Characteristics of Selective Screening for its Detection.\",\"authors\":\"I Miras Aguilar, M Pangua Gómez, L Fidalgo Marrón, E Castaño Andreu, C Llorente Ruiz, G Galicia Poblet, A Aldea Romero, P Álvarez Estrada, A Ortigado Matamala\",\"doi\":\"10.1007/s43465-024-01315-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Backgrounds: </strong>Breech presentation, family history, and physical examination are the most recognized risk factors for DDH, which form the basis of selective screening. However, this approach can lead to late diagnosis, invasive treatments, and complications. This study analyzes the effectiveness of selective screening and identifies additional factors related to DDH.</p><p><strong>Methods: </strong>A retrospective case-control analytical study is designed, including children who are assessed through screening between 2012 and 2019. The variables examined include clinical and gestational characteristics, as well as examination findings. Descriptive analysis is conducted, followed by univariate analysis using Chi-squared, Fisher's exact, or Student's <i>T</i> tests. For multivariate analysis, the \\\"all set\\\" user command is employed. Sensitivity, specificity, and ROC curve are calculated, with a significance level set at <i>p</i> < 0.05. StataIC 16 and SAS System 9.4 are used.</p><p><strong>Results: </strong>762 children are included in the study, of which 33 are diagnosis with DDH. A total of 8,191 models are developed to predict DDH. The best logistic regression model identified the following independent predictors of dysplasia: newborn weight (OR 1.2, 95% CI 1.1-1.4), female sex (OR 3.9; 95% CI 1.4-10.9), cephalic presentation (OR 17.8; 95% CI 2.3-137.3), primiparity (OR 2.6; 95% CI 1.1-5.7), and examination (OR 149.6; 95% CI 18-1121.4). This model correctly classifies 83.6% patients (ROC curve 0.86). In selective screening, examination is the only identified risk factor for DDH, yet its sensitivity does not exceed 10%.</p><p><strong>Conclusions: </strong>This study proposed a total of 8191 models to predict DDH. The identified predictors include female sex, birth weight, cephalic presentation, and primiparity. While physical examination is the primary risk factor, it detects only decentred hips. 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引用次数: 0
摘要
背景：臀位表现、家族史和体格检查是DDH最公认的危险因素，是选择性筛查的基础。然而，这种方法可能导致晚期诊断、侵入性治疗和并发症。本研究分析了选择性筛查的有效性，并确定了与DDH相关的其他因素。方法：设计回顾性病例对照分析研究，纳入2012 - 2019年通过筛查评估的儿童。检查的变量包括临床和妊娠特征，以及检查结果。先进行描述性分析，然后进行单变量分析，使用卡方检验、费雪精确检验或学生T检验。对于多变量分析，使用“all set”用户命令。计算灵敏度、特异度和ROC曲线，显著性水平设为p。结果：共纳入762例患儿，其中诊断为DDH的患儿33例。共建立了8191个模型来预测DDH。最佳logistic回归模型确定了以下发育不良的独立预测因素：新生儿体重（OR 1.2, 95% CI 1.1-1.4）、女性性别(OR 3.9；95% CI 1.4-10.9)，头侧表现(OR 17.8；95% CI 2.3-137.3)，初产(OR 2.6；95% CI 1.1-5.7)和检查(OR 149.6；95% ci 18-1121.4)。该模型对83.6%的患者进行了正确分类（ROC曲线0.86）。在选择性筛查中，检查是唯一确定的DDH危险因素，但其敏感性不超过10%。结论：本研究共提出了8191个DDH预测模型。确定的预测因素包括女性性别、出生体重、头位和初产。虽然身体检查是主要的危险因素，但它只能检测到髋关节脱位。选择性筛查的低灵敏度提出了一个问题，即在目前的实践中，它是否仍然是识别DDH的最合适方法。
Developmental Dysplasia of the Hip: Factors Related to the Diagnosis and Characteristics of Selective Screening for its Detection.
Backgrounds: Breech presentation, family history, and physical examination are the most recognized risk factors for DDH, which form the basis of selective screening. However, this approach can lead to late diagnosis, invasive treatments, and complications. This study analyzes the effectiveness of selective screening and identifies additional factors related to DDH.
Methods: A retrospective case-control analytical study is designed, including children who are assessed through screening between 2012 and 2019. The variables examined include clinical and gestational characteristics, as well as examination findings. Descriptive analysis is conducted, followed by univariate analysis using Chi-squared, Fisher's exact, or Student's T tests. For multivariate analysis, the "all set" user command is employed. Sensitivity, specificity, and ROC curve are calculated, with a significance level set at p < 0.05. StataIC 16 and SAS System 9.4 are used.
Results: 762 children are included in the study, of which 33 are diagnosis with DDH. A total of 8,191 models are developed to predict DDH. The best logistic regression model identified the following independent predictors of dysplasia: newborn weight (OR 1.2, 95% CI 1.1-1.4), female sex (OR 3.9; 95% CI 1.4-10.9), cephalic presentation (OR 17.8; 95% CI 2.3-137.3), primiparity (OR 2.6; 95% CI 1.1-5.7), and examination (OR 149.6; 95% CI 18-1121.4). This model correctly classifies 83.6% patients (ROC curve 0.86). In selective screening, examination is the only identified risk factor for DDH, yet its sensitivity does not exceed 10%.
Conclusions: This study proposed a total of 8191 models to predict DDH. The identified predictors include female sex, birth weight, cephalic presentation, and primiparity. While physical examination is the primary risk factor, it detects only decentred hips. The low sensitivity of selective screening raises questions about whether it remains the most appropriate method for identifying DDH in current practice.
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IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.
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