Type of Proposal
24-3-2015 10:00 AM
24-3-2015 10:50 AM
Schulich School of Medicine Windsor
Importance of the Project
My research aims to identify potential causes for the increased incidence of late diagnosis developmental dysplasia of the hip (DDH) observed in Southwestern Ontario. We will be collecting and interpreting data from all cases referred within the Southwestern Ontario Medical Education Network (SWOMEN). This will allow us to make inferences on the state of DDH as it pertains to the SWOMEN region. This research aims to fill a gap in our current understanding of how DDH is being screened and managed in Southwestern Ontario.
Existing State of Knowledge
Developmental dysplasia of the hip (DDH), formerly congenital dislocation of the hip, affects 1-3% of newborns. Optimal diagnosis of DDH occurs within the first three months of life wherein successful treatment is achievable with various non-invasive orthosis treatments such as a Pavlik Harness or abduction orthosis. A late diagnosis of DDH is considered any diagnosis made after three months of life. Patients diagnosed after three months of life are more likely to fail non-invasive management and require surgical treatments. Current literature shows that approximately 3-10% of all DDH diagnoses are made after this optimal three month window. James T Guille and and M D Sewell are both experts in the field of DDH.
Our project aims to identify a possible reason for the increased incidence of late diagnosis DDH observed in Southwestern Ontario.
We performed a retrospective chart review of the 114 patients who received a diagnosis of DDH between January 1, 2006 and March 2nd, 2014 at London Health Sciences Center. If a diagnosis was made before three months of life patients were categorized as an early diagnosis. A late diagnosis was made in any patient who received a diagnosis after this time period. Patients were further categorized based on the postal code. We considered all patients from London to be urban dwellers, while all other patients were considered to be from community centers. Chi-squared analysis was used to determine any association between these groups.
Forty-four percent of all DDH cases in our study received a delayed diagnosis of DDH. There was no association between being referred from a community center and receiving a delayed diagnosis of DDH (X^2 (2,N=114) = 2.344, p=0.126). There was a significant association between receiving a delayed diagnosis of DDH and having no known risk factors for the condition (X^2 (2,N=114) = 5.254, p < 0.05).
Our data showed no significant association between being referred from a rural center in the Southwestern Ontario Medical Education Network and receiving a delayed diagnosis of DDH. It is important to note, however, that the incidence of late diagnosis DDH in our study was more than double the incidence presently reported in literature. This indicates a need for increased awareness of DDH in both urban and community centers, as well as a strong emphasis on thorough screening for all newborns regardless of their risk factors.
A possible next step will be to survey primary care physicians in the SWOMEN region to gauge their level of knowledge and comfort with diagnosing and managing DDH. Further intervention in the form of CME accredited teaching sessions could be a possible avenue for targeting this issue in the future.
Factors Affecting Late Diagnosis of Developmental Dysplasia of the Hip