Developmental dysplasia of the hip (DDH) is the most common pediatric hip condition, with 1 – 3% of all newborns being diagnosed at birth. DDH represents a spectrum of hip abnormalities, ranging from a mildly dysplastic hip to one that is completely dislocated, resulting in a complete loss of contact between the femoral head and acetabulum. If diagnosed early, DDH can often be managed non-operatively using brace treatment, which allows the hip joint to mature normally. However, undetected or late diagnosed DDH often requires more invasive surgical treatments and potentially further corrective surgeries during childhood and adolescence. Thus, it is essential that DDH is caught promptly in order to avoid poor outcomes. The goal of early diagnosis and treatment of DDH is to establish a concentric hip reduction, restore normal anatomy and development, and prevent subsequent impairment, such as the development of premature hip osteoarthritis. In the past, it has been well established that early diagnosis and treatment of DDH is critical in order to provide patients with the best possible outcome and prevent missed cases.
Various screening programmes have been developed around the world for the early detection of DDH, most of which use clinical exams as the basis of their guidelines with or without ultrasound. These programmes are designed to provide standardized guidance to relevant healthcare providers on the management of DDH using an easy to follow, step-by-step algorithm. Although programmes may differ, all aim to identify all cases of hip instability and dysplasia in a timely manner (before walking age) so that the patient can be observed or treated appropriately. Standardized programmes also help to reduce practice variation among clinicians, which should be avoided as much as possible in order to optimize patient health outcomes. A surveillance guideline must be designed to meet the needs of the local populations and healthcare systems. Because of the need to take into account the local context, it is unlikely that established hip surveillance programmes in Europe and North America are transferrable to developing countries such as India.
The aim of this study is to develop a comprehensive list of consensus items for the screening and diagnosis of developmental dysplasia of the hip (DDH) in India. From this list, a consensus algorithm will be developed that will guide practitioners through the screening and diagnosis process, taking into account any differences in access to resources that may exist in different areas. The goal is to develop practice guidelines that are feasible and can be implemented across the country’s diversity of practice settings. The development of a consensus treatment algorithm for DDH patients that has the potential to benefit many children in India.
Phase of development of Indian guidelines using evidence from literature and consensus-building using the Delphi approach (September - December 2020)
- Develop a framework for the Delphi protocol
- Rate the strength of each recommendation based on evidence & consensus
- Develop a standardized format for reporting the guidelines
- Conduct an internal / ?external peer review of the guidelines
- Develop a process for active dissemination of the guidelines (online, publication, social media, liaise with RBSK/NHM for inclusion in existing screening guidelines, press conferences, CMEs & conferences etc.)
- Develop or adapt tools or derivative products for dissemination (mobile apps, e-learning modules, integration with existing clinical decision support systems)
Phase of dissemination of Guidelines (January - March 2021)
- Implement various tools for active dissemination of guidelines developed
- Set rules & regulations for translation of guidelines into regional languages
- Conduct an internal evaluation of the guideline development process & publish
- Pilot test guidelines with a selected group of end-users from within the Expert Committee or reputed healthcare institutions
- Develop tools to evaluate the effectiveness after implementation
- Set up a policy, procedure & timeline for monitoring literature & assessing whether updation is required in view of new evidence
- Lobby Govt. to adopt Care Pathway & guidelines
- Disseminate information to public & private healthcare sector
- Develop a database of referral centres in each state / district / city where reliable ultrasound is available & where DDH treatment can be provided by Paed Orth experts
Stage of implementation
- Identify & utilize tools to assess outcomes of implementation
This project rests upon four important legs:
- Awareness: Creating awareness among Paediatricians & PCPs about the incidence & deleterious effects of late-diagnosed DDH
- Evidence: Collecting evidence from existing literature the help development of guidelines. Simultaneously to detect gaps in literature for future research.
- Consensus: Generating consensus from experts where evidence is not available by relying on clinical practice & experience.
- Implementation: Ensuring that guidelines are practical & useful for dissemination & immediate implementation
PAEDIATRIC ORTHOPAEDIC SOCIETY OF INDIA
President: Dr. Dhiren Ganjwala
The Paediatric Orthopaedic Society of India was inaugurated in 1994. The objectives were to get together professionals interested in pediatric orthopaedics on a common platform and to serve as an academic body for facilitating exchange of knowledge and technology relevant to pediatric orthopaedics. It currently has about 650 members, making it the 2nd largest Paediatric Orthopaedic Society in the English-speaking world (after POSNA).
INDIAN ACADEMY OF PEDIATRICS
President: Dr. Bakul Parekh
The Indian Academy of Pediatrics was formed by amalgamation of the Association of the Pediatricians of India and the Indian Pediatric Society at its joint conference held in 1963 at Hyderabad. It has now grown over the years to more than 33,000 members, 27 State Branches, 300 Regional / District / City Branches, 18 pediatric subspecialty chapters, 9 Interest Groups and 1 Cell. It also has IAP National Publication House and IAP International Publication House.
NATIONAL NEONATOLOGY FORUM OF INDIA
President: Dr. Ashok Deorari
National Neonatology Forum (NNF) is a strong and large body of more than 8000 Neonatologists across India and abroad. NNF has been actively involved in advocacy, policy making, research and ensuring quality health care to newborn for the last 4 decades. The National Neonatology Forum came into existence in 1980 through the initiative of a handful of leading paediatricians working in the field of neonatology with the following objectives:
- To encourage and advance the knowledge, study and practice of the science of neonatology in the country.
- To draw out recommendations for neonatal care at different levels.
- To establish liaison with other professionals concerned with neonatal care.
- To develop neonatal component of the curriculum for medical as well as nursing teaching.
- To organize conferences, trainings, workshops etc.
- To promote neonatal care in the country.
INDIAN RADIOLOGICAL AND IMAGING ASSOCIATION
President: Dr. Deepak Patkar
Indian Radiological and Imaging Association (IRIA) is promoting the study, the practice of Diagnostic Radiological and Imaging Modalities including X-ray, Ultrasound, C.T., M.R.I., PET CT/MRI, and other Imaging Modalities Radio-Biology, Radiation Medicine, Molecular Imaging and Interventional Radiology and other related subspecialties/super-specialties.
The ‘Indian Radiological Association’ took its birth in 1931 in Calcutta with late Dr. Ajit Mohan Bose as founder President and Dr. Subodh Mitra as founder Secretary. Current membership is ~ 18,000.
INDIAN FEDERATION OF ULTRASOUND IN MEDICINE AND BIOLOGY
President: Dr. Alka Karnik
Indian Federation of Ultrasound in Medicine and Biology IFUMB (formerly) known as Indian Society of Medical Ultrasound) was formed in 1978 by a group of cardiologists, radiologists and gynaecologists from Nair hospital. Current membership is ~2500.
The Federation of Obstetric and Gynaecological Societies of India (FOGSI)
President: Dr. Alpesh Gandhi
FOGSI is the professional organization representing practitioners of obstetrics and gynaecology in India. With 258 member societies and over 37,000 individual members spread over the length and breadth of the country, FOGSI is probably one of the largest membership-based organizations of specialized professionals.