Significant Assessment Discrepancies Occur Between the Examiners Having and Not Having Further Special Hands-on Course Trainings in Infantile Hip Ultrasonography by the Graf Method.

Abstract

The purpose of this retrospective diagnostic study was to investigate whether or not assessment variabilities occurred in hip ultrasonography (US) by the Graf method between the examiners having (CC) and not having (NoCC) additional special hands-on course trainings by the authorized trainers. Randomly selected 270 hip sonograms of 135 babies were independently assessed by CC and NoCC according to the Graf method. An inconsistency between CC and NoCC regarding the US diagnosis was seen in 128 hips (47%). This was mainly due to the fact that CC considered 120 of 128 sonograms unusable according to the checklist of the Graf's examination technique. Probe tilting errors followed by non-visualization of lower limb of os ilium as well as of chondroosseous junction were the most noticed technical problems by CC. There was a significant difference between CC and NoCC concerning the measurement of beta angle. This was mainly due to discordance between the groups about identifying the "bony rim" point. Significant hip US image assessment variabilities exist between the examiners having further trainings by the authorized trainers in special hands-on courses and the examiners having no further trainings in special hands-on courses in the Graf method. The findings of this study may emphasize the importance of training the hip US practitioners in the special hands-on courses for providing a standard clinical practice as well as for avoiding the assessment variabilities between the examiners in the Graf method.