| Abstract | Uvod. Ultrazvuk (UZV) se rutinski koristi u evaluaciji kukova u djece s razvojnim poremećajem kuka, dok se u istu svrhu u djece s cerebralnom paralizom (CP) koristi rendgen. -----
Cilj. Procijeniti dijagnostička svojstva UZV u detekciji decentriranih kukova u djece s CP. -----
Ispitanici i metode. Prospektivna, dijagnostička studija sa “slijepim” istraživačima. Uzastopni bolesnici s CP (dob 2-8 godina) s teškim motornim deficitom pregledani su UZV (lateralni uzdužni snimak za mjerenje lateralne koštane udaljenosti, LKU) te je analizirana i rendgenska slika (migracijski postotak, MP). Dijagnostička svojstva LKU u detekciji kukova s MP≥33% procijenjena su sveukupno (n=100) te za kukove pregledane u dobi 24-60 (n=38) ili 60< do ≤96 mjeseci (n=68). Pedeset su kukova ultrazvukom pregledala dva ispitivača u svrhu evaluacije podudarnosti. -----
Rezultati. Prevalencija kukova s MP≥33% iznosila je 22.0% sveukupno, te 26.2% i 19.4% u dvije dobne podskupine. LKU je dobro razlučila kukove s MP≥33 (površine ispod ROC krivulja 94%, 99% i 92). Pri optimalnim graničnim vrijednostima LKU (5.0, 5.0 i 4.8 mm), senzitivnost je iznosila 95.5% sveukupno, te 100% u svakoj dvije dobne podskupine, dok je specifičnost iznosila 85.9%, 96.4% i 72.0%. Posljedično, pozitivna prediktivna vrijednost bila je relativno niska, ali je negativna prediktivna vrijednost iznosila 98.5% (95% CI 92.1-100) sveukupno i 100% u svakoj od dvije dobne podskupine. Konzistentnost mjerenja dvaju istraživača bila je visoka (ICC= 0.98, 95%CI 0.97-0.99) a 95% granice pouzdanosti razumno uske (-1.203 mm to 0.995 mm). -----
Zaključak. U djece s CP, UZV se može pouzdano rabiti u probiru decentriranih kukova i može u velikoj mjeri smanjiti potrebu za ponovljenim rendgenogramima. |
| Abstract (english) | Background. Ultrasound (US) is routinely used for hip screening in children with developmental hip disorder, whereas surveillance in children with cerebral palsy (CP) is based on repeated X-ray assessments. -----
Objective. To evaluate US as a diagnostic tool in screening for decentered hips in children with CP. -----
Patients and Methods. Prospective, diagnostic assessor-blind study. Consecutive CP patients (age 2-8 years) with severe motor disability underwent US (lateral longitudinal scan to determine lateral head distance, LHD) and X-ray hip assessment (migration percentage, MP). Diagnostic properties of LHD in detecting hips with MP≥33% were evaluated overall (n=100) and for hips assessed at the age 24-60 (n=38) or 60< to ≤96 months (n=68). Fifty hips underwent US assessment by two investigators to evaluate inter-rater reliability and agreement. -----
Results. Prevalence of MP≥33% was 22.0% overall and 26.2% and 19.4% in the two age-based subsets, respectively. LHD well discriminated hips with MP≥33% (areas under the ROC curves 94%, 99% and 92%, respectively). At the optimum cut-off values of LHD (5.0, 5.0 and 4.8 mm, respectively), sensitivity was 95.5% overall and 100% in the two age-based subsets, whereas specificity was 85.9%, 96.4%, 72.0%, respectively. Consequently, positive predictive value was relatively low, but negative predictive value was 98.5% (95% CI 92.1-100) overall and 100% in the two age-based subsets. Inter-rater reliability was high (intraclass correlation coefficient= 0.98, 95%CI 0.97-0.99) and 95% limits of agreement were reasonably narrow (-1.203 mm to 0.995 mm). -----
Conclusion. In children with CP, US can be reliably used in screening for decentered hips and can greatly reduce the need for repeated X-rays. |
