Developmental dysplasia of the hip (DDH) is a common newborn condition with malformation or instability of the hip joint. Identifying DDH early is imperative for avoiding long-term physiologic consequences. In the United States, newborn clinical examination includes DDH screening protocols that employ Ortolani and Barlow maneuvers. Evidence suggests that insufficient training practices for the Ortolani and Barlow exam techniques may lead to unnecessary imaging referrals for further assessment. We investigated the impact of a DDH simulator (MiHip) and training program on ultrasound referral rates at one institution.
From July 2021 to June 2022, 54 residents on newborn rotations participated in training with the MiHip model. All newborns born at our institution one year prior (n=5,404) and one year post-training period (n=5,792) were identified. High-risk factors that automatically result in ultrasound referrals (family history of DDH, breech presentation, and multiple births) were excluded. Following chart analysis of the remaining 9,856 newborns, a Chi-square goodness of fit test was used to compare pre- and post-training incidences of DDH-relevant referrals and unnecessary (defined as DDH negative) ultrasound referrals. p ≤ 0.05 was considered statistically significant, and effect, ω ≥ 0.14 considered large.
Following training, initial referral rates for DDH decreased by 34.07% with a χ2(1, N = 5031) = 34.41, p = 0.02 and ω = 0.08. Unnecessary referrals were reduced by 23% with a χ2(1, N = 33) = 17.96, p = 0.04 and ω = 0.74.
The MiHip curriculum significantly reduced the rate of unnecessary ultrasound referrals, highlighting the benefits of simulation-based training for DDH examination skills. This training could reduce financial and emotional burdens associated with unnecessary imaging, specialist consultations, and follow-up appointments. Future studies will explore the impact of this training on patient outcomes, cost, and refining DDH screening.