Sutton G J, Scanlon P E
Royal Berkshire Hospital NHS Trust, Reading, UK.
Br J Audiol. 1999 Jun;33(3):145-56. doi: 10.3109/03005369909090094.
The Health Visitor Distraction Test (HVDT) screen for hearing was replaced in West Berkshire in 1989 with a vigilance programme incorporating a questionnaire. The detection of permanent congenital deafness (bilateral > 50 dB HL) for all children born since 1984 has been audited to compare the two regimes. Sixty-two cases met the criteria, giving an ascertainment of 1.0 per 1000. Performance was similar under the two systems for severe/profound losses (> 70 dB HL), but there was a longer tail of late-detected moderate losses (50-70 dB HL) under the vigilance regime. The sensitivity of the Health Visitor questionnaire in referring those with permanent hearing loss was very similar to that of the HVDT (39% compared with 42%). Coverage for the questionnaire was approximately 87%, but only 78% for the known cases. Referral rate was lower under the vigilance programme, at approximately 3%. The results suggest that a vigilance programme is likely to perform as well as the HVDT but no better. Despite subsequent modifications to the vigilance programme, the poor pickup of moderate losses probably indicates the limitations of parental and professional observation in detecting partial hearing problems. The evidence adds support to the recent recommendations for universal neonatal screening.
1989年，西伯克郡用一项包含问卷调查的警觉计划取代了健康访视员听力分心测试（HVDT）筛查。对1984年以来出生的所有儿童进行了永久性先天性耳聋（双侧>50 dB HL）检测情况的审核，以比较这两种方法。62例符合标准，确诊率为每1000例中有1.0例。对于重度/极重度听力损失（>70 dB HL），两种系统的表现相似，但在警觉计划下，中度听力损失（50 - 70 dB HL）的晚期检测情况较多。健康访视员问卷在转诊永久性听力损失患者方面的敏感性与HVDT非常相似（分别为39%和42%）。问卷的覆盖率约为87%，但已知病例的覆盖率仅为78%。警觉计划下的转诊率较低，约为3%。结果表明，警觉计划的表现可能与HVDT相当，但不会更好。尽管随后对警觉计划进行了修改，但中度听力损失的检出率较低可能表明在检测部分听力问题方面，家长和专业人员的观察存在局限性。这一证据为最近普遍进行新生儿筛查的建议提供了支持。
