P3.S368: Assessing the accuracy of pediatric faculty in performing the infant hip exam

Background: Developmental dysplasia of the hip (DDH) occurs in 1-2 of every 1,000 infants and can result in significant long-term morbidity if undiagnosed and untreated. The newborn physical examination is a critical screening tool to identify infants at higher risk for DDH. A recent multi-center study conducted by the Better Outcomes through Research for Newborns (BORN) Network of pediatric interns identified that less than half of interns accurately perform the infant hip examination. However, these skills improved significantly with the use of a dedicated curriculum and utilization of an infant hip simulator. In this study, 51% of participating interns reported that they first learned their infant hip exams from faculty pediatricians. While this study provides evidence that dedicated teaching and simulation can improve infant hip exam skills for new learners, there is no previous research assessing the examination skills of attending physicians.

Methods: This was an observational cohort study involving 13 pediatric faculty as part of a larger ongoing multi-site study to assess hip examination skills of pediatric attending physicians. Subjects completed a pre-survey in which they reported the number of times they had performed the infant hip examination. They then demonstrated the exam on infant hip models and their performance was assessed using a checklist derived from textbook descriptions of the Galeazzi, Ortolani and Barlow maneuvers. Both a normal model and model constructed to simulate pathologic exam findings were examined. Data was analyzed using descriptive statistics.

Results: We enrolled 13 faculty pediatricians who directly oversee resident learners. 85% of faculty reported completing more than 500 examinations on live infants, with an average response of 7,746 lifetime examinations per participant. Nearly one-third (30%) of subjects failed to remove the infant’s diaper during examination. Only 30% of faculty correctly assessed for Galeazzi’s sign and only 15% identified abnormal skin folds on the model. 30% of faculty were unable to identify an existing hip dislocation utilizing the Ortolani maneuver and nearly half (47%) of faculty could not correctly identify hip laxity utilizing the Barlow maneuver.

Conclusion: Our study has identified significant variability and low accuracy in this sample of pediatric faculty’s performance of the infant hip exam. Additionally, we have found surprisingly low rates of faculty’s ability to identify abnormal findings indicative of DDH on the infant hip model. Due to the majority of interns reporting that they first learned their exam from faculty physicians, these exam errors may explain the inaccurate exams we previously identified and suggest the impact that faculty clinical skills have on learners. This study further serves to emphasize the importance of the larger ongoing multi-site study to identify faculty pediatrician’s skill in performing the infant hip exam.