Newborn characteristics.

BackgroundWe are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and interpretation of hip ultrasound screening examinations performed by nurses and junior physicians.MethodsA group of 6 nurses and 6 junior physician volunteers with no previous ultrasound experience underwent Graf’s standard training in hands-on practice. Newborns were examined before discharge from the hospital, according to the national guideline. Two standard documentation images of each hip were saved digitally. The groups were compared on the proportion of good quality of sonograms and correct interpretation. Two Swiss supervisors’ agreed diagnosis according to Graf was considered the final reference for the study purposes.ResultsA total of 201 newborns (402 hips or 804 sonograms) were examined in the study, with a mean age of 1.3±0.8 days at examination. Junior physicians examined 100 newborns (200 hips or 400 sonograms), while nurses examined 101 newborns (202 hips or 404 sonograms). The study subjects of the two groups were well balanced for the distribution of baseline characteristics. The study observed no statistically significant difference in the quality of Graf’s standard plane images between the providers. Eventually, 92.0% (92) of the physician group and 89.1% (90) of the nurse group were correctly diagnosed as “Group A” (Graf’s Type 1 hip) or “Non-Group A” hips (p = 0.484). The most common errors among the groups were a missing lower limb, wrong measurement lines, and technical problems.ConclusionOur study provides evidence that while there might be a trend of slightly more technical mistakes in the nurse group, the overall diagnosis accuracy is similar to junior physicians after receiving standard training in Graf’s hip ultrasound method. However, after basic training, regular quality control is a must and all participants should receive refresher trainings. More specifically, nurses need training in the identification of anatomical structures.</div

Univariate analysis of demographic and hip ultrasound examination characteristics of correct and incorrect diagnosis.

Univariate analysis of demographic and hip ultrasound examination characteristics of correct and incorrect diagnosis.</p

Comparison of quality and interpretation of newborn ultrasound screening examinations for developmental dysplasia of the hip by nurses and junior physicians.

Comparison of quality and interpretation of newborn ultrasound screening examinations for developmental dysplasia of the hip by nurses and junior physicians.</p

Hip ultrasound examination performance of the nurses’s and junior physicians‘ groups.

Hip ultrasound examination performance of the nurses’s and junior physicians‘ groups.</p

A hip sonogram.

A. Three landmarks of the standard plane. 1. Standard cut (red arrow), 2. Lower limb or the bottom of the acetabulum (yellow circle), 3. Acetabular labrum and the lateral edge of the acetabulum (blue circle). B. Hip is evaluated by measuring two angles formed by three lines drawn from three landmarks. 1. Basic line (red), 2. Bony roof line (blue), 3. Cartilaginous roof line (yellow).</p

Comparison of Graf types and ABCD groups for hip ultrasound.

Comparison of Graf types and ABCD groups for hip ultrasound.</p

Development of type D hips on person level^a.

<p>^a If a child had hips with different morphologies, the worse hip counted (N=number of children); ^b Numbers in brackets: (X/Y) X=control, Y=treat. Abbreviation: FU, Follow-up visit.</p

Development of type 2a hips on person level^a.

<p>^a If a child had hips with different morphologies, the worse hip counted (N=number of children); ^b Numbers in brackets: (X/Y) X=control, Y=treat. Abbreviation: FU, Follow-up visit; ^c 4^th FU not visualized (2 children with type 1 hips).</p

Development of type 2a hips on hip level^a.

<p>^a Any hip (N=number of hips); ^b Numbers in brackets: (X/Y) X=control, Y=treat. Abbreviation: FU, Follow-up visit; ^c 4^th FU not visualized (3 children with type 1 hips).</p