Table 3

Author, date, and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study weaknesses
USS = ultrasonography.
Adam et al, 1986, UK¹	87 children with irritable hip	Diagnostic	Detection of effusions	28 of 47 children with an effusion on ultrasound had x ray abnormalities	No universal gold standard
Rosenborg and Mortensson, 1986, Sweden²	58 examinations of 47 children, 40 of whom had acute unilateral transient synovitis of the hip	Diagnostic	Detection of effusions	43% of 23 children with an effusion on ultrasound had iliopsoas fatty layer sign on plain x ray, while 52% had and abnormal capsular fat pad sign	No universal gold standard
Zieger et al, 1987, Germany³	123 consecutive patients with suspected joint effusions	Diagnostic	Detection of effusions	USS 100% sensitive	No universal gold standard
				x Ray 27.8% sensitive
Miralles et al, 1989, Spain⁴	500 children with a painful hip or a limp	Diagnostic	Detection of effusions	58 of 235 patients with effusions on ultrasound had abnormal x rays. 4 patients with normal ultrasounds had abnormal x rays	No universal gold standard
			Change in clinical care	USS detection of effusion changed clinical care in only 6 cases
Bickerstaff et al, 1990, UK⁵	111 children with acute hip pain	Diagnostic	Detection of effusions	Effusion detected in 71% by USS but only in 15% by x ray	No universal gold standard
			Change in clinical care	x Ray changed clinical care in only 2 cases (children with Perthes' disease)
Terjesen and Osthus, 1991, Norway⁶	59 children with acute synovitis of the hip	Diagnostic	Detection of effusions	Effusions detected in all patients by USS, but in none by x ray	No universal gold standard