Improving the United Kingdom's Newborn Screening Pathway for Detection of Developmental Dysplasia of the Hip

Background Developmental dysplasia of the hip (DDH) is a significant public health issue and represents the largest cause of hip osteoarthritis in young adults. DDH leads to total hip replacements in around 29% of these patients. The majority (>70%) then undergo multiple hip operations and struggle with persistent pain affecting their daily lives.

This can be prevented with early diagnosis and splint treatment which has a high success rate (>90%).

Delayed diagnosis (after 3 months old) leads to a higher risk of surgical complications and a sevenfold increase in treatment costs. The current UK screening programme has shown no improvement in early detection of DDH since 1986.

There is no national clinical consensus on ultrasound diagnostic parameters and indications for treatment; this has led to regional variation. Cochrane review has confirmed the lack of evidence to support the current programme. Objectives 1.

To develop a UK consensus-based 'core measurement set' detailing ultrasound features that should inform early diagnosis and treatment in DDH, which would facilitate screening programme standardisation. 2.

To investigate the potential for computer programmes to automatically identify hip features and calculate measurements from ultrasound images, allowing for improved reliability and reproducibility. Methods 1.

A systematic review of studies reporting early (≤3 months) ultrasound features in DDH that are associated with need for treatment.

This will report the predictive characteristics (e.g. sensitivity, specificity, likelihood ratios) of different scanning methods. 2.

A UK-based Delphi consensus exercise to identify early ultrasound features/measurements that inform diagnosis and treatment of DDH.

This will allow development of a 'core measurement set' to reduce regional variation and facilitate high-quality research. 3.

Development of an artificial intelligence model to automatically delineate an 'adequate' ultrasound scan image, then reliably calculate and report the 'core measurement set'. Learning and non-learning methods will be evaluated against manual techniques.

Anticipated impact This topic has been identified as a UK research priority by patients, carers and clinicians through the 2019 James Lind Alliance Priority Setting Partnership.

The study aim has been supported by the UK National Screening Committee who recognise the need to improve evidence around screening for DDH.

The project will deliver a multidisciplinary consensus to reduce regional variation, improve diagnosis and effectively monitor treatment outcomes. This will improve the ability of the screening programme to identify babies that will benefit from treatment.

Automating the assessment of ultrasound images could lead to a cost-effective and reliable means of measuring and recording hip-specific measurements.

Consistent measurements using a standardised platform are likely to improve inter-observer reliability and facilitate further research aimed at optimising the screening programme.

Dissemination Findings will be published open access in appropriate high impact peer-reviewed journals aimed at an international audience.

They will also be presented at international meetings of clinicians and academics in the fields of DDH and medical technology. Patients and the public will be updated via a bespoke website, social media and charity newsletters. Our experience of working with patients and the public will be published on the NIHR INVOLVE website.