Thomas R E, Spragins W, Mazloum G, Cronkhite M, Maru G
Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Independent Research Consultant, Calgary, Alberta, Canada.
Child Care Health Dev. 2016 May;42(3):382-93. doi: 10.1111/cch.12333. Epub 2016 Apr 8.
Early and regular developmental screening can improve children's development through early intervention but is insufficiently used. Most developmental problems are readily evident at the 18-month well-baby visit. This trial's purpose is to: (1) compare identification rates of developmental problems by GPs/family physicians using four evidence-based tools with non-evidence based screening, and (2) ascertain whether the four tools can be completed in 10-min pre-visit on a computer.
We compared two approaches to early identification via random assignment of 54 families to either: 'usual care' (informal judgment including ad-hoc milestones, n = 25); or (2) 'Evidence-based' care (use of four validated, accurate screening tools, n = 29), including: the Parents' Evaluation of Developmental Status (PEDS), the PEDS-Developmental Milestones (PEDS-DM), the Modified Checklist for Autism in Toddlers (M-CHAT) and PHQ9 (maternal depression).
In the 'usual care' group four (16%) and in the evidence-based tools group 18 (62%) were identified as having a possible developmental problem. In the evidence-based tools group three infants were to be recalled at 24 months for language checks (no specialist referrals made). In the 'usual care' group four problems were identified: one child was referred for speech therapy, two to return to check language at 24 months and a mother to discuss depression. All forms were completed on-line within 10 min.
Despite higher early detection rates in the evidence-based care group, there were no differences in referral rates between evidence-based and usual-care groups. This suggests that clinicians: (1) override evidence-based screening results with informal judgment; and/or (2) need assistance understanding test results and making referrals. Possible solutions are improve the quality of information obtained from the screening process, improved training of physicians, improved support for individual practices and acceptance by the regional health authority for overall responsibility for screening and creation of a comprehensive network.
早期定期发育筛查可通过早期干预改善儿童发育，但目前使用不足。大多数发育问题在18个月龄健康婴儿访视时就很明显。本试验的目的是：（1）比较全科医生/家庭医生使用四种循证工具与非循证筛查方法对发育问题的识别率；（2）确定这四种工具能否在就诊前10分钟内在电脑上完成。
我们通过随机分配54个家庭，比较了两种早期识别方法：“常规护理”（包括临时发育里程碑的非正式判断，n = 25）；或（2）“循证护理”（使用四种经过验证的准确筛查工具，n = 29），包括：父母发育状况评估（PEDS）、PEDS发育里程碑（PEDS-DM）、改良幼儿自闭症检查表（M-CHAT）和PHQ9（母亲抑郁量表）。
“常规护理”组中有4名（16%）儿童，循证工具组中有18名（62%）儿童被确定可能存在发育问题。在循证工具组中，有3名婴儿在24个月时被召回进行语言检查（未进行专科转诊）。在“常规护理”组中，发现了4个问题：1名儿童被转诊接受言语治疗，2名儿童在24个月时返回检查语言能力，1名母亲被要求讨论抑郁问题。所有表格均在10分钟内在线完成。
尽管循证护理组的早期检测率较高，但循证护理组和常规护理组之间的转诊率没有差异。这表明临床医生：（1）用非正式判断推翻循证筛查结果；和/或（2）需要帮助来理解检测结果并进行转诊。可能的解决方案包括提高筛查过程中获得的信息质量、改善医生培训、加强对个体诊所的支持以及让地区卫生当局接受对筛查的全面责任并建立一个综合网络。
