Association of objective structured clinical examination performance on nurse-led hip ultrasound imaging success: A prospective cohort study.

Background: Conventional physical examinations sometimes fail to detect developmental hip dysplasia. Ultrasound hip screening, non-invasive and radiation-free, can identify these cases earlier, and nurse-led maternal, newborn, and infant home visits and childcare consultations at community health centers offer an ideal platform for community implementation. Knowing the relationship between Objective Structured Clinical Examination scores and nurses' ability to capture diagnostic-quality hip images would inform training standards and credentialing, ensuring safe scale-up of nurse-led hip-screening services. However, this link remains unknown. Objective: To examine the association between Objective Structured Clinical Examination performance and nurses' success in capturing standard hip ultrasound images during maternal and child health service consultations. Design: Prospective cohort study. Settings: Three municipalities in Japan. Participants: The study included 21 nurses (18 public health nurses, 1 registered nurse, and 2 midwives). Methods: Participants completed an e-learning course, knowledge tests, hands-on training seminars, and the Objective Structured Clinical Examination before undergoing ultrasound examinations during home visits. Two trained researchers assessed exam performance using a global rating scale (range: 1-6), total score (range: 0-360 points), image acquisition time, and successful capture of standard images of the right and left hips using phantoms-infant-shaped models for training ultrasound hip screening. Pediatric orthopedic surgeons evaluated the ultrasound images obtained during home visits between February 2024 and May 2025. Linear regression analysis examined the associations among participant demographics, examination performance, and imaging success rates. Results: The mean examination global rating score was 4.48 (standard deviation = 0.66), and the mean total score was 330.8 (standard deviation = 22.0). During home visits, 611 ultrasound examinations were conducted, of which 494 (80.9%) were successful. The success rate did not vary substantially based on the cumulative number of examinations performed by each nurse. Lower age (B = -5.2, p = 0.030) and successfully capturing a standard plane of the left hip during the examination were associated with significantly higher imaging success rates in maternal and child health service consultations (84.7% vs. 71.4%, p = 0.039). A shorter image acquisition time (B = -0.1, p = 0.009) was also significantly associated with higher success rates. Conclusions: Successful capture of left-hip image and faster performance during the Objective Structured Clinical Examination independently predicted nurses' field imaging success, supporting this examination as a readiness checkpoint and guide for targeted remediation. Registration: University Hospital Medical Information Network Clinical Trial Registry; UMIN000051929 (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000059248). Registration date: 16/09/2023. Start of recruitment: 01/11/2023. Social media abstract: Objective structured clinical examinations predict the success of nurses in hip ultrasound screening during real-world practices.