Skellern C Y, Rogers Y, O'Callaghan M J
Royal Childrens' Hospital and District Health Service, Brisbane, Queensland, Australia.
J Paediatr Child Health. 2001 Apr;37(2):125-9. doi: 10.1046/j.1440-1754.2001.00604.x.
Premature infants are at increased risk of developmental disability. Early identification of problems allows intervention to ameliorate or attenuate problems. A reliable screening tool allows triage of children in this high-risk population by identifying those unlikely to need full developmental assessment. To explore the test characteristics of an established parent-completed developmental assessment questionnaire 'Ages and Stages Questionnaire' (ASQ) in follow up of an Australian population of premature infants.
One hundred and sixty-seven children born prematurely with corrected ages 12- to 48-months attending the Growth and Development Clinic at the Mater Children's Hospital in Brisbane, Queensland, Australia; 136 questionnaires 'ASQ' were returned completed (81%) and were compared to formal psychometric assessment (Griffith Mental Development Scales for 12- and 24-months, Bayley Mental Development Intelligence Scale for 18-months, McCarthy General Cognitive Intelligence Scale for 48-months). Developmental delay was considered to be present if any of the above psychometric assessments fell below 1.0 standard deviations (SD). The ASQ cut-off used was 2.0 SD (US data derived means and SD).
Aggregate results for all age groups comparing ASQ to psychometric assessments as 'gold standards' found the ASQ to have the following test characteristics: sensitivity (90%); specificity (77%); positive predictive value (40%); negative predictive value (98%); % over-referred (20%); % under-referred (1%); % agreement (79%). Likelihood ratio for children failing the ASQ was 3.8 and for passing the ASQ was 0.13. Twenty-one children with known disabilities were included in the study and in 14 of these, the ASQ overall score agreed with the psychometric assessment (67%).
The high negative predictive value of the ASQ supports its use as a screening tool for cognitive and motor delays in the follow up of ex-premature infants. This would need to be combined with other strategies as part of a comprehensive follow up program for ex-premature infants.
早产儿出现发育障碍的风险更高。尽早发现问题有助于进行干预，以改善或减轻这些问题。可靠的筛查工具能够通过识别那些不太可能需要全面发育评估的儿童，对这一高风险人群进行分流。本研究旨在探究一份已确立的由家长完成的发育评估问卷——“年龄与阶段问卷”（ASQ）在澳大利亚早产儿群体随访中的测试特征。
167名矫正年龄为12至48个月的早产儿，他们在澳大利亚昆士兰州布里斯班的马特儿童医院生长发育门诊就诊；共收回136份已完成的“ASQ”问卷（81%），并将其与正式的心理测量评估进行比较（12个月和24个月时使用格里菲斯心理发展量表，18个月时使用贝利心理发展智力量表，48个月时使用麦卡锡一般认知智力量表）。如果上述任何一项心理测量评估结果低于1.0个标准差（SD），则认为存在发育迟缓。所使用的ASQ临界值为2.0 SD（源自美国数据的均值和标准差）。
将ASQ与作为“金标准”的心理测量评估进行比较，所有年龄组的汇总结果显示ASQ具有以下测试特征：灵敏度（90%）；特异度（77%）；阳性预测值（40%）；阴性预测值（98%）；过度转诊率（20%）；漏诊率（1%）；一致率（79%）。ASQ测试未通过儿童的似然比为3.8，通过儿童的似然比为0.13。21名已知有残疾的儿童纳入了研究，其中14名儿童的ASQ总分与心理测量评估结果一致（67%）。
ASQ的高阴性预测值支持将其用作早产婴儿随访中认知和运动迟缓的筛查工具。这需要与其他策略相结合，作为早产婴儿综合随访计划的一部分。
