Is it difficult to obtain inter-observer agreement in the measurement of the beta angle in ultrasound evaluation of the paediatric hip?

Ozgun Karakus,Hasan Hilmi Muratli,Mehmet Mufit Orak,Ahmet Sinan Sari,Ozgur Karaman

doi:10.1186/s13018-019-1263-1

Abstract

IntroductionThe aim of this study was to determine the differences and consistencies in the morphological and angular interpretations of standard USG images. Therefore, it was aimed to show the correlations of orthopaedic doctors with different periods of experience in hip ultrasound measurements taken with the Graf method.Materials and methodsThe study included 210 infants randomly selected from those who presented at our hospital for DDH screening. A total of 6 ultrasound images were taken for each hip. These images were evaluated by two paediatric orthopaedic professors, two orthopaedic specialists and two orthopaedic residents. The correlations of these measurements between all the doctors were evaluated statistically.ResultsIn beta angle evaluation, agreement between all the evaluators was at the level of 0.054. No agreement was seen between the two residents or between the two specialists (p = 0.003, p = 0.998, p = 0.998, respectively). Agreement between the two professors was determined at the level of 0.508 (p < 0.001). Agreement was determined at the level of 0.066 between the specialists and the residents. No agreement was observed between the specialists and the professors or between the professors and the residents (p = 0.014, p = 0.098, p = 0.737, respectively).ConclusionsIt can be concluded that greater emphasis on the beta angle, the cartilage labrum, and more detailed explanations of this subject in the resident training program will achieve standardisation on this subject, and this is in direct proportion to clinical experience.Level of evidenceIV

Highlights

The aim of this study was to determine the differences and consistencies in the morphological and angular interpretations of standard USG images
It can be concluded that greater emphasis on the beta angle, the cartilage labrum, and more detailed explanations of this subject in the resident training program will achieve standardisation on this subject, and this is in direct proportion to clinical experience
Developmental dysplasia of the hip (DDH) is a clinical condition seen in a wide range varying from acetabular dysplasia which has disrupted the normal relationship between the femoral head and the acetabulum to a decentralised hip which has completely lost the joint relationship [1, 2]

Summary

Introduction

The aim of this study was to determine the differences and consistencies in the morphological and angular interpretations of standard USG images. It was aimed to show the correlations of orthopaedic doctors with different periods of experience in hip ultrasound measurements taken with the Graf method. DDH is the most commonly seen musculoskeletal system anomaly in childhood and, if not identified and treated, can lead to permanent deformities and arthrosis, causing loss of workforce and reduced quality of life. The importance of early diagnosis in treatment has been proven, and in this respect, ultrasonography has become the currently recommended standard method [3, 4]. Hip ultrasonography is widely accepted as the primary method for screening, diagnosis and follow-up of treatment of DDH in newborns [5,6,7,8,9]. The most important factor determining the success of treatment is early diagnosis. Sequelae-free recovery is possible with treatment in the first months of life, while cases that are delayed can experience severe difficulties in treatment and permanent

Objectives

Methods

Results

Conclusion