35 - Improving Screening for Developmental Dysplasia of the Hip in the Setting of External Cephalic Version

Publication Number: 2032.35

Angela C. Judd, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States; Anna Pullicino, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States; Abhinav Parikh, NewYork-Presbyterian Komansky Children’s Hospital, Brooklyn, NY, United States

Background: Developmental dysplasia of the hip (DDH) occurs when fetal or postnatal positioning hinders proper growth. Ultrasound (US) for DDH is recommended for infants with family history, suggestive physical exam or breech position. External cephalic version (ECV) is performed to avoid Cesarean section in the setting of fetal breech positioning. Despite successful ECV infants continue to have elevated risk of DDH compared to the general population. Therefore, DDH US screening is recommended in this population. This requires the ordering provider to have knowledge of what ECV is, know whether it occurred during pregnancy and what the US screening guidelines are.

Objective: To determine if an educational intervention for pediatric residents changes their documentation and recommendation practices for infants with history of ECV.

Design/Methods: Retrospective chart review of gestational parent and neonate with history of attempted ECV found via SlicerDicer procedure code. Neonatal admission history and physical (H&P) and discharge summary were reviewed for documentation of ECV and recommendation for US screening.
Educational intervention involved a lecture discussing ECV, DDH, and the importance of documentation and recommendation for screening US given to pediatric residents. This intervention also included discussion of the retrospective chart review findings. A pre- and post- intervention survey assessed residents' changes in knowledge, documentation and recommendation practices.

Results: 36 of 144 (25%) infants with ECV during their third trimester had ECV documented in chart. Recommendation for screening US was documented 65 of 144 (45%) of discharge summaries. 18 residents participated in the intervention. The pre and post survey demonstrated an increase in the number of residents reporting that they know what ECV is from 94% to 100% and an increase in the number reporting that they would recommend US screening in the setting of ECV from 83% to 100%. Before the intervention 28% of residents reported that they would look specifically for history of ECV when reviewing the gestation parent's chart compared to 100% after (p < 0.01). The post intervention survey also recorded 100% commitment to recommending US screening in the setting of ECV.

Conclusion(s): Poor documentation of ECV and recommendation for DDH screening US was found in the majority of reviewed charts. After the intervention residents reported better understanding of ECV, the need for screening US and an increased commitment to documentation. All pediatric residents should be taught about ECV with the ultimate goal of improving screening for DDH.

DDH Risk Factors Documented in Newborn Chart
A retrospective review of 144 neonatal charts with known history of breech position and attempted external cephalic version. This graph depicts the percent documentation of ECV, history of breech position and recommendation for US screening at 6 weeks.

Pre and Post Educational Intervention
Before the intervention 28% of pediatric residents reported that they would look specifically for history of ECV when reviewing the gestational parent (maternal) chart compared to 100% after (p < 0.01).