Hansen Robin L, Blum Nathan J, Gaham Amy, Shults Justine
Department of Pediatrics, University of California-Davis School of Medicine, Davis, California; MIND Institute, University of California-Davis, Sacramento, California;
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Pediatrics. 2016 Feb;137 Suppl 2:S79-89. doi: 10.1542/peds.2015-2851F.
To describe the clinical practices of physicians in the Developmental-Behavioral Pediatrics Network (DBPNet) to (1) diagnose autism spectrum disorders (ASDs), identify comorbidities, and evaluate etiology and (2) compare actual practice to established guidelines.
A total of 56 developmental-behavioral pediatricians completed encounter forms, including demographic/clinical information, for up to 10 consecutive new-patient visits given a diagnosis of ASD. Data were summarized by using descriptive statistics. Analysis of the statistical significance of differences between sites (n = 10) used general estimating equations and mixed-effects logistic regression to adjust for clustering by clinician within site.
A total of 284 ASD forms were submitted. Most assessments (56%) were completed in 1 visit (27.5% in 2 visits, 8.6% in 3 visits). Use of the Childhood Autism Rating Scale, Autism Diagnostic Observation Schedule, or Screening Tool for Autism in Toddlers and Young Children varied across sites from 28.6% to 100% of encounters (P < .001). A developmental assessment was reviewed/completed at 87.7% of encounters (range: 77.8%-100%; P = .061), parent behavior rating scales were reviewed/completed at 65.9% (range: 35.7%-91.4%; P = .19), and teacher behavior rating scales were reviewed/completed at 38.4% (range: 15%-69.2%; P = .19). Only 17.3% (95% confidence interval: 12.8%-21.7%) of evaluations were completed by an interdisciplinary team. A majority (71%) of patients had at least 1 comorbid diagnosis (31% had at least 2 and 12% at had least 3). Etiologic evaluations were primarily genetic (karyotype: 49%; microarray: 69.7%; fragile X: 71.5%).
Despite site variability, the majority of diagnostic evaluations for ASD within DBPNet were completed by developmental-behavioral pediatricians without an interdisciplinary team and included a developmental assessment, ASD-specific assessment tools, and parent behavior rating scales. These findings document the multiple components of assessment used by DBPNet physicians and where they align with existing guidelines.
描述发育行为儿科学网络（DBPNet）中医生的临床实践，以（1）诊断自闭症谱系障碍（ASD）、识别共病并评估病因，以及（2）将实际实践与既定指南进行比较。
共有56名发育行为儿科医生填写了会诊表格，包括人口统计学/临床信息，针对最多10次连续的新患者就诊给出ASD诊断。数据采用描述性统计进行汇总。对各站点（n = 10）之间差异的统计学显著性分析使用了广义估计方程和混合效应逻辑回归，以调整同一站点内医生的聚类情况。
共提交了284份ASD表格。大多数评估（56%）在1次就诊时完成（2次就诊完成的占27.5%，3次就诊完成的占8.6%）。《儿童自闭症评定量表》《自闭症诊断观察量表》或《幼儿自闭症筛查工具》的使用在各站点之间有所不同，占会诊的比例从28.6%到100%不等（P < .001）。87.7%的会诊进行了发育评估（范围：77.8% - 100%；P = .061），65.9%的会诊查阅/完成了家长行为评定量表（范围：35.7% - 91.4%；P = .19），38.4%的会诊查阅/完成了教师行为评定量表（范围：15% - 69.2%；P = .19）。只有17.3%（95%置信区间：12.8% - 21.7%）的评估由跨学科团队完成。大多数（71%）患者至少有1种共病诊断（31%至少有2种，12%至少有3种）。病因评估主要是基因方面的（核型：49%；微阵列：69.7%；脆性X：71.5%）。
尽管各站点存在差异，但DBPNet中大多数ASD诊断评估是由发育行为儿科医生在没有跨学科团队的情况下完成的，包括发育评估、ASD特异性评估工具和家长行为评定量表。这些发现记录了DBPNet医生使用的评估的多个组成部分以及它们与现有指南的契合之处。
