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  • Guideline Summary
  • NGC:010160
  • 1999 (revised 2013)

ACR Appropriateness Criteria® developmental dysplasia of the hip — child.

Dempsey ME, Karmazyn B, Coley BD, Dillman JR, Dory CE, Garber M, Hayes LL, Milla SS, Raske ME, Rice HE, Rigsby CK, Strouse PJ, Westra SJ, Widmann RF, Wootton-Gorges SL, Expert Panel on Pediatric Imaging. ACR Appropriateness Criteria® developmental dysplasia of the hip--child. [online publication]. Reston (VA): American College of Radiology (ACR); 2013. 7 p. [40 references]

View the original guideline documentation External Web Site Policy

This is the current release of the guideline.

This guideline updates a previous version: Karmazyn BK, Gunderman R, Coley BD, Bulas D, Garber M, Keller MS, Meyer JS, Milla SS, Paidas C, Pizzutillo PD, Podberesky DJ, Prince JS, Expert Panel on Pediatric Imaging. ACR Appropriateness Criteria® developmental dysplasia of the hip -- child. [online publication]. Reston (VA): American College of Radiology (ACR); 2010. 5 p.

Major Recommendations

ACR Appropriateness Criteria®

Clinical Condition: Developmental Dysplasia of the Hip – Child

Variant 1: Patient younger than 4–6 months of age, positive physical findings (Ortolani or Barlow maneuvers).

Radiologic Procedure Rating Comments RRL*
US hips 8 This procedure is preferably used in patients 4–6 weeks of age. O
X-ray pelvis AP view 2   radioactive radioactive
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 2: Patient younger than 4–6 months of age, equivocal physical findings.

Radiologic Procedure Rating Comments RRL*
US hips 8 This procedure is preferably used in patients 4–6 weeks of age. O
X-ray pelvis AP view 2   radioactive radioactive
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 3: Patient younger than 4–6 months of age, female with breech presentation (primiparae most at risk), or positive family history without physical findings.

Radiologic Procedure Rating Comments RRL*
US hips 8 This procedure is preferably used in patients 4–6 weeks of age. O
X-ray pelvis AP view 2   radioactive radioactive
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 4: Patient 4–6 months of age or older, clinically suspicious for DDH (limited abduction or abnormal gait).

Radiologic Procedure Rating Comments RRL*
X-ray pelvis AP view 8 In this procedure, consider using no shield for the first examination only. radioactive radioactive
US hips 3 This procedure can be used if the femoral heads are not yet ossified. O
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Summary of Literature Review

Introduction/Background

Definition

Developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip, comprises a spectrum of abnormalities that include abnormal acetabular shape (dysplasia) and malposition of the femoral head, ranging from dislocatable hip and mild subluxation to fixed dislocation.

Incidence

It is difficult to assess the true incidence of DDH, as the definition varies and there is no gold-standard test. Incidence varies from 1.5 to 20 in 1,000 births. In the United States, DDH affects approximately 1.5 of 1,000 Caucasians but is less frequent among African Americans. It is 4 to 8 times more common in females, patients with a family history of DDH, first-born children, infants born in the breech presentation (particularly primiparae breech, as frank breech is the most common position and leads to the greatest risk), large infants, and infants with a history of oligohydramnios. It occurs 3 times more frequently in the left hip than in the right, likely due to the normal left occiput anterior position in utero, which places the infant's left hip against the mother's spine and limits its abduction.

Etiology

The origin and pathogenesis of DDH are multifactorial. Abnormal laxity of the ligaments and hip capsule is seen in patients with DDH. The maternal hormone relaxin may also be a factor. Causes of oligohydramnios are thought to be reduced in utero space, movement restriction, and being a first-born child. Extreme hip flexion with knee extension, as in the breech position, tends to promote femoral head dislocation and leads to the shortening and contracture of the iliopsoas muscle.

Natural History

The natural history of DDH depends on the type and degree of hip abnormality. Mild dysplasia may never manifest clinically or become apparent until adult life, whereas severe dysplasia is most likely to present clinically during childhood. Most DDH identified during the newborn period represents hip laxity and immaturity. Approximately 60% to 80% of abnormalities identified by physical examination and more than 90% identified by ultrasound (US) resolve spontaneously. Untreated subluxed and dislocated hips can lead to early degenerative joint disease and impaired function.

Diagnosis

Clinical examination or imaging methods, such as radiography or US, can be used to diagnose DDH.

Clinical Evaluation

The American Academy of Pediatrics recommends a well-baby visit at 1–2 weeks and at 2, 4, 6, 9, and 12 months of age. As part of the clinical evaluation, it is important to elicit risk factors for DDH. Findings suggesting DDH include asymmetric skin folds in the proximal thigh and shortening of the thigh on the dislocated side. Confirmatory findings include a positive Ortolani test or a positive Barlow test. The Ortolani maneuver is used to determine whether the femoral head shifts in and out of the acetabulum. If the femoral head is positioned out of the acetabulum in the resting position (dislocated), but can be placed into the acetabulum during the Ortolani maneuver (often with a "clunk" that can be felt), it is considered to be a positive Ortolani test. If the femoral head is located in the acetabulum at rest, but can be displaced out of the acetabulum during the Ortolani maneuver due to joint capsule laxity, it is considered to be a positive Barlow test.

In children >3 months of age, these tests are unlikely to be elicited. Limitation of hip abduction and asymmetric thigh folds secondary to shortening are more useful clinical signs of DDH. Once a child is walking, there is a typical limp, and the child often toe-walks on the affected side. If both hips are dislocated, increased lumbar lordosis, prominent buttocks, and a waddling gait pattern are present.

The sensitivity and specificity of the clinical examination depend on the expertise of the evaluator. An inexperienced examiner may have difficulty differentiating the "clunk" felt during the Ortolani maneuver in a dislocated hip and a nonspecific "click" felt during the same maneuver. This "click" may be related to the psoas tendon, ligamentum teres, or fascia lata in extremes of abduction but is not reflective of an unstable hip. Effectiveness of clinical screening varies, depending on whether an orthopedic surgeon, experienced pediatrician, or intern performs the examination.

Radiographic Evaluation

Radiographs are readily available and relatively low in cost. The main limitations are radiation exposure and radiography's inability to demonstrate the cartilaginous femoral head. Radiographs are of limited value during an infant's first 3 months of life, when the femoral heads are composed entirely of cartilage, but they become more reliable for use in infants 4 to 6 months of age, with the appearance of femoral head ossification.

Radiographs may be performed to assess the hips in children with a clinical diagnosis of DDH, to monitor hip development after treatment, and to assess longer-term outcomes. Radiographs are also valuable for assessing other bony abnormalities in patients who have neuromuscular disorders, myelodysplasia, or arthrogryposis (teratologic dislocation). The imaging assessment (radiographic and sonographic) of hip dysplasia in this population is similar to the assessment of variants of DDH in an otherwise healthy child.

An anteroposterior (AP) radiograph of the pelvis should be obtained with the hips in a neutral position. To visualize all structures in a young child, consideration should be given to taking the first radiograph without a shield. In a child with developed ossified epiphyseal nuclei and a widened joint space (subluxated but not a frankly dislocated hip), an abduction internal rotation view may be obtained to confirm that the femoral head can be positioned deeply within the acetabulum. On the AP pelvis radiograph, measurement of the acetabular index is an objective parameter that can be used in the diagnosis and follow-up of patients with DDH. However, interobserver variability casts doubt on the reliability of the acetabular index based on a single reading.

Ultrasound Evaluation

US evaluation of the hip is performed using a high-frequency linear array transducer. Two methods have emerged: a static acetabular morphology method proposed by Graf and a dynamic stress technique proposed by Harcke.

The Graf method is based on a single coronal image. Graf developed a morphologic and geometric hip classification scheme (types I–IV) using an alpha angle, which measures the osseous acetabular roof angle, and a beta angle, which defines the position of the echogenic fibrocartilaginous acetabular labrum. The different categories can be grouped into 3 types:

  • Normal hip: Type I hips are normal and require no treatment. The alpha angle is greater than 60°.
  • Immature hip: Type IIa hips are seen in infants <3 months of age. The hip is normally located, but the bony acetabulum promontory is rounded and the alpha angle is 50° to 59°. These patients require no treatment, and there is a small risk of delayed DDH. Follow-up is recommended to confirm normal development.
  • Abnormal hip: Type IIb has similar features to type IIa, but it is detected in children >3 months of age. Types IIc, D, III, and IV represent progressive abnormal hips with frank subluxation in types III and IV. The alpha angle is <50° in types IIc and D and <43° in types III and IV.

Interobserver variability raises concerns about the operator dependence of US evaluation for DDH and could explain the variability of US screen-positive rates reported in the literature.

Harcke developed the dynamic or real-time method, using US to attempt to visualize the Barlow and Ortolani maneuvers. This technique is performed in both the coronal and transverse planes, with and without stress. The modified Barlow maneuver is performed by holding the knee with the hip flexed 90° and in adduction. The femur is pushed (pistoned) posteriorly. The American College of Radiology (ACR) guidelines for hip US combine the static and dynamic techniques.

US during an infant's first 4 weeks of life often reveals the presence of minor degrees of instability and acetabular immaturity in a normal hip; however, nearly all of these resolve on follow-up. To increase the reliability of this test, it is recommended that US studies be performed when infants are 4 to 6 weeks of age.

Other Imaging Modalities

Computed tomography (CT) and magnetic resonance imaging (MRI) can be used to evaluate DDH in patients with casts, following surgery for closed reduction, to confirm that the hip has been successfully reduced. CT and MRI can also be used to evaluate complex hip dislocations, for presurgical planning, and for evaluation of avascular necrosis (AVN).

Arthrography

Following closed reduction of the subluxated or dislocated hip, the orthopedic surgeon uses arthrography to confirm concentric position of the femoral head and assess the depth and stability of the reduction and shape of the labrum for infolding. If the closed reduction does not result in a stable congruent joint, the surgeon may move to an open reduction to improve hip alignment.

Ultrasound Screening for Developmental Dysplasia of the Hip

There is no consensus on the best screening method for DDH. The goals of a screening program are early detection in all patients who have DDH, when therapy is most effective and noninvasive, and identification of patients without DDH, for whom unnecessary treatment could be costly and harmful. Delayed diagnosis increases the risk of complications, and infants diagnosed after 6 months of age often require surgical correction. However, screening carries potential harm. Most of the clinically and US-detected cases of DDH will resolve spontaneously; therefore, screening can lead to overtreatment. The most common and serious complication of nonsurgical treatment is AVN. Choosing the best method of screening is a complex decision, as evidenced by a recent United States Preventive Services Task Force that was "unable to assess the balance of benefits and harms of screening" for DDH. Two types of screening can be performed: universal screening, in which all neonates are evaluated, and selective screening, in which only those at high risk are evaluated. These types of screening apply to both physical and sonographic assessment.

Universal Ultrasound Screening

Universal US screening for DDH in newborns is performed in some European countries. Universal screening increases DDH detection, which leads to higher rates of treatment with abduction splinting; however, there is no evidence that it reduces the time to diagnose DDH. This may lead to increased expense, unnecessary treatment, and increased post-treatment complications of AVN. For these reasons, the American Academy of Pediatrics did not recommend universal screening.

Selective Ultrasound Screening

Risk Factors

Risk factors for DDH include breech presentation, positive family history, and female gender. Additional risk factors include maternal primiparity, oligohydramnios, and congenital anomalies. The American Academy of Pediatrics recommends hip imaging for female infants born in the breech position and optional hip imaging for males born in the breech position or females with a positive family history of DDH.

Selective US screening can identify DDH in children at high risk for DDH who have had a negative physical examination. However, selective US screening has not been shown to significantly reduce the time to diagnose DDH.

Positive Physical Examination

The American Academy of Pediatrics guideline published in 2000 did not recommend US screening after a positive physical examination. However, recent studies have shown that 41% to 58% of abnormal findings from a physical examination were negative when US was used, thus leading to unnecessary treatment. A prospective 33-center United Kingdom Hip Trial addressed the value of selected US screening in infants following a positive physical examination. It found that US examinations in infants with clinically detected hip instability allowed for a reduction in abduction splinting and was not associated with an increase in abnormal hip development or higher rates of surgical treatment. This policy was found to reduce costs.

Treatment

It is widely assumed that early treatment results in improved outcome. There is agreement in the literature that patients who have a hip dislocation should be treated and that those who have stable, "clicking" hips should be followed clinically; however, there is some disagreement regarding the treatment of patients who have unstable (lax, but not displaced) hips ("Barlow-positive"). Some authors advocate early treatment for every patient who has instability. Others prefer clinical observation because a significant number of these patients (80%) progress spontaneously to a clinically normal status.

Summary

  • Recent studies show that 41% to 58% of abnormal findings from physical examinations were negative in US studies, thus confirming the value of US evaluation.
  • A study by the United Kingdom Hip Trial found that US screening was associated with reduced abduction splinting in infants with a clinically detected hip instability and was not associated with an increase in abnormal hip development or higher rates of surgical treatment.
  • Performing hip US in children following a positive physical examination was found to reduce costs (Elbourne et al., 2002).
  • Based on a thorough review of the literature, Children's Hospital of Boston, Massachusetts, published a decision-tree analysis. Fold-back analysis and sensitivity analysis were performed. Researchers concluded that the optimum strategy, associated with the highest probability of having a nonarthritic hip at 60 years of age, was to use physical examination to screen all neonates for hip dysplasia and use hip US selectively for infants who are at high risk for DDH (Mahan, Katz, & Kim, 2009).
  • The American Academy of Pediatrics guideline published in 2000 did not recommend US following a positive physical examination.

Abbreviations

  • AP, anteroposterior
  • DDH, developmental dysplasia of the hip
  • US, ultrasound

Relative Radiation Level Designations

Relative Radiation Level* Adult Effective Dose Estimate Range Pediatric Effective Dose Estimate Range
O 0 mSv 0 mSv
radioactive <0.1 mSv <0.03 mSv
radioactive radioactive 0.1-1 mSv 0.03-0.3 mSv
radioactive radioactive radioactive 1-10 mSv 0.3-3 mSv
radioactive radioactive radioactive radioactive 10-30 mSv 3-10 mSv
radioactive radioactive radioactive radioactive radioactive 30-100 mSv 10-30 mSv
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as "Varies".

Clinical Algorithm(s)

Algorithms were not developed from criteria guidelines.

Disease/Condition(s)

Developmental dysplasia of the hip

Guideline Category

Diagnosis

Evaluation

Risk Assessment

Screening

Clinical Specialty

Family Practice

Orthopedic Surgery

Pediatrics

Radiology

Intended Users

Health Plans

Hospitals

Managed Care Organizations

Physicians

Utilization Management

Guideline Objective(s)

To evaluate the appropriateness of initial radiologic examinations for developmental dysplasia of the hip (DDH)

Target Population

  • All newborns (for universal screening)
  • Infants at high risk of developmental dysplasia of the hip (DDH) (for selective screening)

Interventions and Practices Considered

  1. X-ray pelvis anteroposterior (AP) view
  2. Ultrasound (US) hips

Major Outcomes Considered

Utility of radiologic examinations in differential diagnosis

Methods Used to Collect/Select the Evidence

Searches of Electronic Databases

Description of Methods Used to Collect/Select the Evidence

Literature Search Procedure

Staff will search in PubMed only for peer reviewed medical literature for routine searches. Any article or guideline may be used by the author in the narrative but those materials may have been identified outside of the routine literature search process.

The Medline literature search is based on keywords provided by the topic author. The two general classes of keywords are those related to the condition (e.g., ankle pain, fever) and those that describe the diagnostic or therapeutic intervention of interest (e.g., mammography, MRI).

The search terms and parameters are manipulated to produce the most relevant, current evidence to address the American College of Radiology Appropriateness Criteria (ACR AC) topic being reviewed or developed. Combining the clinical conditions and diagnostic modalities or therapeutic procedures narrows the search to be relevant to the topic. Exploding the term "diagnostic imaging" captures relevant results for diagnostic topics.

The following criteria/limits are used in the searches.

  1. Articles that have abstracts available and are concerned with humans.
  2. Restrict the search to the year prior to the last topic update or in some cases the author of the topic may specify which year range to use in the search. For new topics, the year range is restricted to the last 10 years unless the topic author provides other instructions.
  3. May restrict the search to Adults only or Pediatrics only.
  4. Articles consisting of only summaries or case reports are often excluded from final results.

The search strategy may be revised to improve the output as needed.

Number of Source Documents

The total number of source documents identified as the result of the literature search is not known.

Methods Used to Assess the Quality and Strength of the Evidence

Weighting According to a Rating Scheme (Scheme Given)

Rating Scheme for the Strength of the Evidence

Strength of Evidence Key

Category 1 - The conclusions of the study are valid and strongly supported by study design, analysis and results.

Category 2 - The conclusions of the study are likely valid, but study design does not permit certainty.

Category 3 - The conclusions of the study may be valid but the evidence supporting the conclusions is inconclusive or equivocal.

Category 4 - The conclusions of the study may not be valid because the evidence may not be reliable given the study design or analysis.

Methods Used to Analyze the Evidence

Systematic Review with Evidence Tables

Description of the Methods Used to Analyze the Evidence

The topic author drafts or revises the narrative text summarizing the evidence found in the literature. American College of Radiology (ACR) staff draft an evidence table based on the analysis of the selected literature. These tables rate the strength of the evidence (study quality) for each article included in the narrative text.

The expert panel reviews the narrative text, evidence table, and the supporting literature for each of the topic-variant combinations and assigns an appropriateness rating for each procedure listed in the table. Each individual panel member assigns a rating based on his/her interpretation of the available evidence.

More information about the evidence table development process can be found in the ACR Appropriateness Criteria® Evidence Table Development document (see the "Availability of Companion Documents" field).

Methods Used to Formulate the Recommendations

Expert Consensus (Delphi)

Description of Methods Used to Formulate the Recommendations

Rating Appropriateness

The appropriateness ratings for each of the procedures included in the Appropriateness Criteria topics are determined using a modified Delphi methodology. A series of surveys are conducted to elicit each panelist's expert interpretation of the evidence, based on the available data, regarding the appropriateness of an imaging or therapeutic procedure for a specific clinical scenario. American College of Radiology (ACR) staff distribute surveys to the panelists along with the evidence table and narrative. Each panelist interprets the available evidence and rates each procedure. The surveys are completed by panelists without consulting other panelists. The appropriateness rating scale is an ordinal scale that uses integers from 1 to 9 grouped into three categories: 1, 2, or 3 are in the category "usually not appropriate"; 4, 5, or 6 are in the category "may be appropriate"; and 7, 8, or 9 are in the category "usually appropriate." Each panel member assigns one rating for each procedure for a clinical scenario. The ratings assigned by each panel member are presented in a table displaying the frequency distribution of the ratings without identifying which members provided any particular rating.

If consensus is reached, the median rating is assigned as the panel's final recommendation/rating. Consensus is defined as eighty percent (80%) agreement within a rating category. A maximum of three rounds may be conducted to reach consensus. Consensus among the panel members must be achieved to determine the final rating for each procedure.

If consensus is not reached, the panel is convened by conference call. The strengths and weaknesses of each imaging procedure that has not reached consensus are discussed and a final rating is proposed. If the panelists on the call agree, the rating is proposed as the panel's consensus. The document is circulated to all the panelists to make the final determination. If consensus cannot be reached on the call or when the document is circulated, "No consensus" appears in the rating column and the reasons for this decision are added to the comment sections.

This modified Delphi method enables each panelist to express individual interpretations of the evidence and his or her expert opinion without excessive influence from fellow panelists in a simple, standardized and economical process. A more detailed explanation of the complete process can be found in additional methodology documents found on the ACR Web site External Web Site Policy (see also the "Availability of Companion Documents" field).

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

The guideline developers reviewed published cost analyses.

Method of Guideline Validation

Internal Peer Review

Description of Method of Guideline Validation

Criteria developed by the Expert Panels are reviewed by the American College of Radiology (ACR) Committee on Appropriateness Criteria.

References Supporting the Recommendations

Elbourne D, Dezateux C, Arthur R, Clarke NM, Gray A, King A, Quinn A, Gardner F, Russell G, UK Collaborative Hip Trial Group. Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial. Lancet. 2002 Dec 21-28;360(9350):2009-17. PubMed External Web Site Policy

Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am. 2009 Jul;91(7):1705-19. PubMed External Web Site Policy

Type of Evidence Supporting the Recommendations

The recommendations are based on analysis of the current literature and expert panel consensus.

Potential Benefits

Selection of appropriate radiologic imaging procedures for evaluation and early diagnosis of developmental dysplasia of the hip (DDH)

Potential Harms

  • Delayed diagnosis increases the risk of complications, and infants diagnosed after 6 months of age often require surgical correction.
  • Screening carries potential harm. Most of the clinically and ultrasound (US)-detected cases of developmental dysplasia of the hip (DDH) will resolve spontaneously; therefore, screening can lead to overtreatment. The most common and serious complication of nonsurgical treatment is avascular necrosis (AVN).

Relative Radiation Level (RRL)

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, both because of organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared to those specified for adults. Additional information regarding radiation dose assessment for imaging examinations can be found in the American College of Radiology (ACR) Appropriateness Criteria® Radiation Dose Assessment Introduction document (see the "Availability of Companion Documents" field).

Qualifying Statements

The American College of Radiology (ACR) Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the U.S. Food and Drug Administration (FDA) have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.

Description of Implementation Strategy

An implementation strategy was not provided.

IOM Care Need

Getting Better

Staying Healthy

IOM Domain

Effectiveness

Timeliness

Bibliographic Source(s)

Dempsey ME, Karmazyn B, Coley BD, Dillman JR, Dory CE, Garber M, Hayes LL, Milla SS, Raske ME, Rice HE, Rigsby CK, Strouse PJ, Westra SJ, Widmann RF, Wootton-Gorges SL, Expert Panel on Pediatric Imaging. ACR Appropriateness Criteria® developmental dysplasia of the hip--child. [online publication]. Reston (VA): American College of Radiology (ACR); 2013. 7 p. [40 references]

Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released

1999 (revised 2013)

Guideline Developer(s)

American College of Radiology - Medical Specialty Society

Source(s) of Funding

The American College of Radiology (ACR) provided the funding and the resources for these ACR Appropriateness Criteria®.

Guideline Committee

Committee on Appropriateness Criteria, Expert Panel on Pediatric Imaging

Composition of Group That Authored the Guideline

Panel Members: Molly E. Dempsey, MD (Principal Author); Boaz Karmazyn, MD (Co-Author and Panel Vice-chair); Brian D. Coley, MD (Panel Chair); Jonathan R. Dillman, MD; Christopher E. Dory, MD; Matthew Garber, MD; Laura L. Hayes, MD; Sarah S. Milla, MD; Molly E. Raske, MD; Henry E. Rice, MD; Cynthia K. Rigsby, MD; Peter J. Strouse, MD; Sjirk J. Westra, MD; Roger F. Widmann, MD; Sandra L. Wootton-Gorges, MD

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Karmazyn BK, Gunderman R, Coley BD, Bulas D, Garber M, Keller MS, Meyer JS, Milla SS, Paidas C, Pizzutillo PD, Podberesky DJ, Prince JS, Expert Panel on Pediatric Imaging. ACR Appropriateness Criteria® developmental dysplasia of the hip -- child. [online publication]. Reston (VA): American College of Radiology (ACR); 2010. 5 p.

Guideline Availability

Available from the American College of Radiology (ACR) Web site External Web Site Policy.

Print copies: Available from the American College of Radiology, 1891 Preston White Drive, Reston, VA 20191. Telephone: (703) 648-8900.

Availability of Companion Documents

The following are available:

  • ACR Appropriateness Criteria®. Overview. Reston (VA): American College of Radiology; 2013 Nov. 3 p. Available from the American College of Radiology (ACR) Web site External Web Site Policy.
  • ACR Appropriateness Criteria®. Literature search process. Reston (VA): American College of Radiology; 2013 Apr. 1 p. Available from the ACR Web site External Web Site Policy.
  • ACR Appropriateness Criteria®. Evidence table development. Reston (VA): American College of Radiology; 2015 Nov. 5 p. Available from the ACR Web site External Web Site Policy.
  • ACR Appropriateness Criteria®. Radiation dose assessment introduction. Reston (VA): American College of Radiology; 2013 Nov. 3 p. Available from the ACR Web site External Web Site Policy.
  • ACR Appropriateness Criteria®. Procedure information. Reston (VA): American College of Radiology; 2103 Apr. 1 p. Available from the ACR Web site External Web Site Policy.
  • ACR Appropriateness Criteria® developmental dysplasia of the hip. Evidence table. Reston (VA): American College of Radiology; 2013. 11 p. Available from the ACR Web site External Web Site Policy.

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI on March 29, 2006. This NGC summary was updated by ECRI Institute on July 2, 2009. This NGC summary was updated by ECRI Institute on December 10, 2010. This NGC summary was updated by ECRI Institute on February 27, 2014.

Copyright Statement

Instructions for downloading, use, and reproduction of the American College of Radiology (ACR) Appropriateness Criteria® may be found on the ACR Web site External Web Site Policy.

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