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    The costs of late detection of developmental dysplasia of the hip

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    URI
    http://hdl.handle.net/11287/593835
    Author
    Woodacre, Timothy
    Dhadwal, A.
    Ball, T.
    Edwards, C.
    Cox, Peter J.
    Date
    2014-08-01
    Journal
    Journal of children's orthopaedics
    Type
    Journal Article
    Publisher
    Springer
    DOI
    10.1007/s11832-014-0599-7
    Metadata
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    Abstract
    PURPOSE: Debate currently exists regarding the economic viability for screening for developmental dysplasia of the hip in infants. METHODS: A prospective study of infant hip dysplasia over the period of 1998-2008 (36,960 live births) was performed to determine treatment complexity and associated costs of disease detection and hospital treatment, related to the age at presentation and treatment modality. The involved screening programme utilised universal clinical screening of all infants and selective ultrasound screening of at-risk infants. RESULTS: One hundred and seventy-nine infants (4.8/1,000) presented with hip dysplasia. Thirty-four infants presented late (> 3 months of age) and required closed or open reduction. One hundred and forty-five infants presented at < 3 months of age, 14 of whom failed early Pavlik harness treatment. A detailed cost analysis revealed: 131 early presenters with successful management in a Pavlik harness at a cost of pound601/child; 34 late presenters who required surgery (36 hips, 19 closed/17 open reductions, one revision procedure) at a cost of pound4,352/child; and 14 early presenters with failed management in a Pavlik harness requiring more protracted surgery (18 hips, four closed/14 open reductions, seven revision procedures) at a cost of pound7,052/child. CONCLUSIONS: Late detection causes increased treatment complexity and a sevenfold increase in the short-term costs of treatment, compared to early detection and successful management in a Pavlik harness. DISCUSSION: Improved strategies are needed for the 10 % of early presenting infants who fail Pavlik harness treatment and require the most complex and costly interventions.
    Citation
    J Child Orthop. 2014 Aug;8(4):325-32.
    Publisher URL
    http://dx.doi.org/10.1007/s11832-014-0599-7
    Note
    This article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.
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    • 2014 RD&E publications
    • General Trauma & Orthopaedics

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