Diagnostic Accuracy of Clinical Examination, Ultrasonography, and Radiography for Developmental Dysplasia of the Hip in Infants: A Prospective Diagnostic-Accuracy Cohort Study
DOI:
https://doi.org/10.31674/mjn.2026.v18i01.014Abstract
Background: Developmental Dysplasia of the Hip (DDH) requires early recognition and appropriate age imaging to reduce delayed diagnosis and the need for more complex treatment. Nurses contribute to risk recognition, caregiver education, referral coordination, and follow-up, although nursing outcomes were not evaluated in this diagnostic study. Objectives: To compare the diagnostic performance of clinical examination, ultrasonography, and radiography for DDH in at-risk infants using a common composite reference standard. Methods: This prospective diagnostic-accuracy cohort study included 416 infants aged from birth to 12 months who had at least one stated risk factor for DDH. Participants underwent standardized clinical examination, Graf-method ultrasonography, and age-appropriate anteroposterior pelvic radiography. Final DDH classification was based on follow-up radiography at approximately 6 months of age and pediatric orthopedic adjudication. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV), with 95% Confidence Intervals (CIs), were reported for each index test. Results: Ultrasonography had a reported sensitivity of 71.0% (95% CI, 65.5%-76.0%) and a specificity of 69.0% (95% CI, 60.7%-76.3%). Clinical examination had a sensitivity of 54.0% (95% CI, 48.2%-59.7%) and specificity of 64.0% (95% CI, 55.5%-71.7%), whereas radiography had a sensitivity of 71.0% (95% CI, 65.5%-76.0%) and specificity of 39.0% (95% CI, 31.1%-47.5%). Conclusion: Ultrasonography provided the most favorable reported balance of sensitivity and specificity in this selected high-risk cohort, while clinical examination remained an important first-line assessment and radiography provided age-dependent structural information. The findings support a coordinated, age-appropriate diagnostic pathway rather than reliance on a single modality. For nursing practice, the results emphasize standardized risk documentation, timely communication with pediatric and radiology teams, caregiver education, and closed-loop follow-up; however, direct nursing competencies, interventions, and outcomes should be evaluated in future studies.
Keywords:
Clinical Examination, Developmental Dysplasia of the Hip, Diagnostic Accuracy, Infant, Nursing Practice, Radiography, UltrasonographyDownloads
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