Abstract
Purpose of the study
To determine the consistency with which specialist orthopaedic surgeons rate the importance of criteria for the diagnosis of DDH which had previously been generated in a BSCOS and EPOS multi national study.
Methods
163 members of BSCOS received a questionnaire containing 37 criteria that, in a previous study, had been found to be important for the diagnosis of DDH in infants under 8 weeks. A visual analogue scale was used to rate the importance of each criterion in the diagnosis of DDH. We determined the consistency using the intra-class correlation coefficient (values > .80 are anticipated). Analyses were preformed for all members of BSCOS and for geographic regions.
Results
The response rate was 61%. Cronbach's α was .98 indicating that the pattern of the data observed was stable. The overall consistency was poor for all 37 criteria (ICC = .39 [95% CI .29, .52]). Surgeons were least consistent about criteria related to ultrasound (ICC = .25). The consistency for criteria related to patient characteristics (ICC = .40) and x-ray (ICC= .32) was better. Surgeons were most consistent (ICC = .51) about criteria related to clinical examination. Analyses based on regions of England, Scotland and Wales improved consistency by 25% (best ICC = .47) with West Midland, Yorkshire and Scotland rating top three.
Conclusion
Surgeons' opinion about the importance of criteria for the diagnosis of DDH varies substantially across the UK. This study suggests a need to develop widely accepted criteria for the diagnosis of DDH that can be applied with sufficient degree of consistency among surgeons. Reducing inconsistency in this area should improve diagnosis and treatment.
