ECAD Study: Evaluating agreement degree among paediatricians in hip dysplasia assessment by Graf ultrasound method

Abstract

Introduction: developmental dysplasia of the hip (DDH) is the most common musculoskeletal anomaly of childhood. This study analyses paediatrician’s concordance performing hip ultrasound according to Graf's method. Materials and methods an analytical cross-sectional study is designed. Patients’ hips are evaluated by Graf´s ultrasound method at 4–6 and 12–16 weeks of age. Demographic characteristics, pregnancy history, factors related to DDH, hip type, and α and β angles are collected. To assess agreement degree of hip diagnosis and hip types Kappa index (I. kappa) is used. Intraclass correlation coefficient (ICC) evaluates concordance of α and β angles. A p value < 0.05 is considered to be statistically significant. All results are represented with their 95% confidence interval (95% CI). Results 467 neonates are recruited and meet inclusion criteria. 3182 images were analysed. Agreement between paediatricians according to hip diagnosis and different types ranges from moderate to almost perfect I. kappa 0.6–1.0 (95%CI 0.5–0.7; 95%CI 1.0–1.0). α angle ICC for paediatricians is between 0.75–0.88 (95%CI 0.61–0.86; 95%CI 0.80–0.92). β angle value agreement degree among paediatricians at both visits is moderate. Discussion Graf method is the most popular ultrasound technique for hip assessment. In our setting, paediatricians carry out children follow-up, therefore, they should perform universal screening. In this study agreement degree between paediatricians varies between substantial and almost perfect. As conclusion, Graf ultrasound procedure performed by paediatricians is a reliable test and can be used for DDH screening.