Using Z-score to optimize population-specific DDH screening: a retrospective study in Hangzhou, China

BMC Musculoskeletal Disorders

Haomin Li¹  Qiang Shu¹  Jingjing Ye²  Jin Yu²  Liqi Shu³  Huilong Duan⁴  Zeng Xian⁴ 

[1] Clinical Data Center, National Clinical Research Center for Child Health, The Children’s Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, 310052, Hangzhou, China;Department of Ultrasound, The Children’s Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, 310052, Hangzhou, China;Rhode Island Hospital, Brown University, Providence, USA;The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China;

关键词: DDH screening;    Graf typing;    Z-score;    False positive;   

DOI  :  10.1186/s12891-021-04216-6

来源: Springer

【 摘 要 】

BackgroundDDH (Developmental Dysplasia of the Hip) screening can potentially avert many morbidities and reduce costs. The debate about universal vs. selective DDH ultrasonography screening in different countries revolves to a large extent around effectiveness, cost, and the possibility of overdiagnosis and overtreatment. In this study, we proposed and evaluated a Z-score enhanced Graf method to optimize population-specific DDH screening.MethodsA total of 39,710 history ultrasonography hip examinations were collected to establish a sex, side specific and age-based Z-scores model using the local regression method. The correlation between Z-scores and classic Graf types was analyzed. Four thousand two hundred twenty-nine cases with follow-up ultrasonographic examinations and 5284 cases with follow-up X-ray examinations were used to evaluate the false positive rate of the first examination based on the subsequent examinations. The results using classic Graf types and the Z-score enhanced types were compared.ResultsThe Z-score enhanced Graf types were highly correlated with the classic Graf’s classification (R = 0.67, p < 0.001). Using the Z-scores ≥2 as a threshold could reduce by 86.56 and 80.44% the false positives in the left and right hips based on the follow-up ultrasonographic examinations, and reduce by 78.99% false-positive cases based on the follow-up X-ray examinations, respectively.ConclusionsUsing an age, sex and side specific Z-scores enhanced Graf’s method can better control the false positive rate in DDH screening among different populations.

【 授权许可】

CC BY