A systematic review 1 including 10 studies was abstracted in DARE. One diagnostic accuracy study used a historical control group (n=7,236), 2 RCTs (n=28,554), and 7 non-randomised studies (the numbers were unclear in 2 studies and ranged from 1,422 to 89,200 in the other 5 studies) were included. Two RCTs compared the prevalence of late (after 1 month) diagnosis of DDH after ultrasonography plus clinical screening with clinical screening alone, and found lower rates (although not statistically significant) after ultrasonography. Another study defined late diagnosis as diagnosis after 8 months and found similar rates of 'missed' cases for ultrasonography compared with clinical screening. Another study defined late diagnosis as diagnosis after 8 months and found similar rates of 'missed' cases for ultrasonography compared with clinical screening. Six out of 7 studies reported an increase in overall treatment rate with ultrasonography. One of 2 studies reported a reduction in the duration of treatment after ultrasonography, while the other reported that screening at birth led to shorter treatment duration than screening at 3 to 4 months. One diagnostic accuracy study, which used a reference standard that was not independent of the index test and might not have identified the target condition, reported a sensitivity of 88.5% (95% CI: 84.1 to 92.1) and a specificity of 96.7% (95% CI: 96.4 to 97.4) for ultrasonography
Comment: The quality of evidence is downgraded by indirectness (insufficient data on treatment outcome after screening) and limitations in study methodology. The authors conclude that ultrasound screening can not yet be recommended.
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