Diagnostic Accuracy of Ultrasonography Method of Graf in the Detection of Developmental Dysplasia of the Hip: A Meta-Analysis and Systematic Review

The present study aimed to perform a meta-analysis on the performance of Graf’s ultrasonographymethod in the detection of developmental dysplasia of the hip (DDH).

A query was conducted on electronic bibliographic databases until the end of October 2020. The inclusioncriteria entailed: 1. the use of Graf method in less than 12 weeks of age, 2. the use of follow-up as reference test, and 3.provision of crude data. Pooled diagnostic performance measures were calculated. Quality Assessment of DiagnosticAccuracy Studies-2 (QUADAS-2) checklist was utilized to assess the quality of the included studies. The hierarchicalsummary receiver-operating characteristic (HROC) curves were also drawn.

Six articles (including seven populations, 11,012 patients) were considered eligible. The pooled sensitivityand specificity were obtained at 93% (95% CI: 0.57-0.99) and 97% (95% CI:0.86-0.99), respectively (area under curve=0.99). The pooled positive and negative likelihood ratio, as well as diagnostic odds ratio, was reported as 28.4, 0.07,and 396, respectively.

As evidenced by the obtained results, Graf’s method is a useful ultrasonography technique with acceptableaccuracy for screening DDH in neonates. However, there are uncertainties about the best population and age forscreening. Furthermore, more attention should be paid to the proper training of this method to reduce the number ofoperator errors.Level of evidence: I