Screening for Developmental Dysplasia of the Hip [Internet]
Bibliographic record
Abstract
Context Developmental dysplasia of the hip (DDH) can lead to the later development of chronic pain, osteoarthritis, and limitations in activity. Screening for DDH has been practiced for over 40 years, but recommendations from major professional societies differ. Objective To synthesize the evidence on risks and benefits of screening for DDH. Data Sources MEDLINE (through Sept, 2004), Cochrane CENTRAL, and previous comprehensive literature reviews. Study Selection We focused our review on information gaps identified in previous reviews conducted for the American Academy of Pediatrics and the Canadian Task Force on Preventive Health Care. Specifically, we focused on comparative studies of clinical examination vs. ultrasound screening; studies of the effect of nonsurgical and surgical treatments for DDH on functional outcomes; and studies reporting rates of avascular necrosis with different interventions. Data Extraction Using present criteria, the authors assessed the quality of included trials and abstracted information about settings, patients, interventions, and outcomes. Data Synthesis No published trials directly link screening to improved functional outcomes. Clinical examination and ultrasound identify somewhat different groups of newborns at risk for DDH; the lack of an untreated cohort or definitive gold standard made it impossible to estimate sensitivity and specificity for the different tests. Few studies examine the functional outcomes of patients who have undergone therapy for DDH. Due to the high rate and unpredictable nature of spontaneous resolution of DDH and the absence of comparative studies of intervention vs. no intervention, the effectiveness of interventions is not known. Avascular necrosis (AVN) of the hip, the most common and most severe harm of all treatments for DDH, can result in growth arrest of the hip and eventual joint destruction with significant disability. Reported rates of AVN very widely. Conclusion Screening with clinical examination or ultrasound can identify newborns at risk for DDH, but due to the high rate of spontaneous resolution of neonatal hip instability and dysplasia and the lack of evidence of the effectiveness of interventions on functional outcomes, the net benefits of screening are not clear. Key Words DDH, Hip Dysplasia, mass screening
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.012 | 0.011 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.032 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".