How Ready are Pediatricians and Family Physicians in Saudi Arabia to Perform Clinical Screening of Developmental Dysplasia of the Hip?

Figures & data

Table 1 Participant Characteristics

Parameter	Category	Frequency	Percentage
Region	Western	136	33.2%
	Central	134	32.7%
	Eastern	140	34.1%
Sex	Male	179	43.7%
	Female	231	56.3%
Discipline	Pediatrician	203	49.5%
	Family physician	207	50.5%
Academic Level	Consultant	231	56.3%
	Specialist	144	35.1%
	Resident	35	8.7%
Exposure to DDH screening in routine practice	No.	131	32.0%
	Yes	276	67.3%
	No answer	3	0.7%

Table 2 Accuracy of Responses in Different Knowledge Dimensions in the Total Study Population and in Pediatricians versus Family Physicians

Knowledge Dimension	Scores – Mean (SD)
	Total	Pediatricians	Family Physicians	p-value
Previously considered risk factors	0.69 (0.15)	0.71 (0.15)	0.66 (0.15)	0.001*
Currently considered risk factors	0.83 (0.11)	0.83 (0.11)	0.83 (0.12)	0.903
Appropriate screening age	0.73 (0.44)	0.83 (0.37)	0.63 (0.48)	<0.001*
Effects of swaddling	0.22 (0.42)	0.28 (0.45)	0.16 (0.37)	0.003*
Incidence of DDH in KSA	0.10 (0.30)	0.11 (0.32)	0.09 (0.29)	0.454
Physical signs	0.61 (0.22)	0.64 (0.22)	0.57 (0.21)	0.001*
Clinical significance of hip click	0.63 (0.21)	0.62 (0.22)	0.63 (0.20)	0.953
Management of high-risk infant with negative physical examination	0.24 (0.35)	0.29 (0.39)	0.20 (0.30)	0.010*
Management of the infant with positive physical examination	0.61 (0.40)	0.67 (0.40)	0.55 (0.40)	0.002*
Advice to mother on swaddling	0.51 (0.41)	0.52 (0.42)	0.50 (0.40)	0.606
Self-reported confidence in performing Ortolani and Barlow maneuvers	0.74 (0.23)	0.80 (0.22)	0.69 (0.22)	<0.001*
CKS score	53.8 (11.6)	57.5 (12.1)	50.2 (9.9)	<0.001*

Notes: Values are given in terms of mean (SD) and are calculated out of 1 for all knowledge dimensions and out of 100 for the CKS (clinical knowledge and skills) score. The higher the value, the better the level of knowledge. A comparison between pediatricians and family physicians was performed using an independent t-test. *p-values <0.05 were considered statistically significant results.

Figure 1 Knowledge among pediatricians and family physicians in Saudi Arabia about the risk factors currently considered for Hip developmental dysplasia in infants. Bars represent the percentage of participants who correctly identified (dark bars) or correctly excluded (light bars) the given factor.

Figure 2 Knowledge among pediatricians and family physicians in Saudi Arabia about physical signs of developmental dysplasia of the Hip in infants. Bars represent the percentage of participants who correctly identified (dark bars) or correctly excluded (light bars) the given sign.

Table 3 Factors Associated with Clinical Knowledge and Skills in Screening for Developmental Dysplasia of the Hip in Infants

Factor/Category	N	CKS Score, Mean (SD)	p-value^a	Adequate CKS Level, %	p-value^b
Region			<0.001*		0.008*
Western	136	51.3 (9.8)		33.8
Central	134	57.3 (13.3)		51.5
Eastern	140	52.9 (10.7)		37.9
Sex			0.897		0.459
Male	179	53. (12.0)		43.0
Female	231	53.7 (11.3)		39.4
Discipline			<0.001*		<0.001*
Pediatrician	203	57.5 (12.1)		52.2
Family physician	207	50.2 (9.9)		30.0
Academic level			0.415		0.820
Resident	35	51.6 (12.3)		40.0
Specialist	144	53.5 (11.2)		43.1
Consultant	231	54.3 (11.8)		39.8
Exposure to DDH screening in routine practice			<0.001*		<0.001*
No	131	49.4 (6.3)		16.8
Yes	276	55.9 (12.9)		52.9
Confidence in performing Ortolani and Barlow maneuvers^§			<0.001*		<0.001*
0	2	33.5 (3.6)		0.0
0.25	18	47.7 (8.7)		22.2
0.50	110	51.7 (11.6)		36.4
1	145	60.4 (12.6)		69.7

Notes: ^§Levels are defined as: 0, Never heard of it or read about it, 0.25; Theoretical knowledge only; 0.50, Practicing but not confident; 1, Practicing and fully confident. Tests used: ^aOne-way ANOVA or independent t-test, as applicable, ^bChi-square test; *p-values <0.05 were considered statistically significant differences (p<0.05).