Purpose or Case Report: International data have shown that a hip surveillance program decreased and even prevented hip dislocations in children with cerebral palsy (CP). There are however, no published guidelines on reporting hip abnormalities in these children. Radiologic terminology and measurement technique varied widely in our department. The purpose of our quality improvement initiative was to standardize radiographic hip surveillance imaging and reporting as part of the newly implemented screening program at our institution.
Methods & Materials: Technologists were educated on the importance of uniform patient positioning. Next, we standardized measurement technique and reporting for screening pelvis radiographs with a report template and education via conferences, online module, and posttest for our pediatric radiologists. The primary metric was measurement of migration percentage (MP) of each hip, a quantification of hip subluxation. Nonstandard terms were discouraged. Report impressions categorized patients’ hip abnormalities based on risk of dislocation (low, medium, and high). Compliance with the reporting template was tracked over 5 months and results reviewed.
Results: In the first 5 months, 183 (81%) of 225 children with CP referred for radiographic hip screening were found to have at least 1 abnormal hip. Reports using the standard template and terminology with MP measurement and risk category descriptions increased from 22 (of 42, 52%) in the first month to 35 (of 36, 97%) in the last month. Nine (5%) of the reports in the first 3 months and none in the last 2 months, included MP without including the risk category, while 44 (23%) of the reports in the first 4 months and none in the last month lacked current terminology. Only 2 exams had unsatisfactory positioning for migration measurement. There were no previously unrecognized hip dislocations, though two children demonstrated rapid increase in hip migration (from 30 to > 60% hip migration) during our study period, which prompted surgical intervention.
Conclusions: A successful hip surveillance program requires meticulous radiographic positioning, uniform measurement technique, and dislocation risk categorization, in order to promote timely detection, referral, and treatment of hip abnormalities in children with CP.