Am Fam Physician. 2007 May 1;75(9):1304.
to the editor: The article, “Developmental Dysplasia of the Hip,” provides an informative review and recommends screening for this disorder in infants using physical examination maneuvers based on C level evidence.1 The authors acknowledge that the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to recommend routine screening because of the high rate of natural resolution of hip abnormalities that are found on physical examination and ultrasonography.2 However, they did not mention other considerations that led to the USPSTF's conclusion: the limited accuracy of diagnostic tests and the lack of evidence of effectiveness for, and potential harm from, surgical and non-surgical treatments.2 These potential harms are not well studied and include unnecessary tests, health care costs, avascular necrosis, and complications of surgery and anesthesia.
The AAFP has adopted a policy that agrees with the USPSTF3; both of these recommendations apply only to infants who are asymptomatic and not to those with obvious hip dislocations or other hip abnormalities.2,3 When judging whether to perform screening tests, family physicians need to evaluate the proven and potential harms and benefits. The former are often underestimated or not considered for procedures supported only by common practice and expert opinion.
1. Storer SK, Skaggs DL. Developmental dysplasia of the hip. Am Fam Physician. 2006;74:1310–6.
2. Agency for Healthcare Research and Quality. Screening for developmental dysplasia of the hip. U.S. Preventive Services Task Force: recommendation statement. Accessed April 13, 2007, at: http://www.ahrq.gov/clinic/uspstf/uspshipd.htm.
3. American Academy of Family Physicians. A-E: Recommendations for clinical preventive services. Accessed April 13, 2007, at: http://www.aafp.org/patient-care/clinical-recommendations/cps.html.
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