Sutantio Jennie D, Pusponegoro Hardiono D, Sekartini Rini
Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Child Neurology Division, University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Telemed J E Health. 2021 Apr;27(4):427-431. doi: 10.1089/tmj.2020.0035. Epub 2020 May 7.
Delayed diagnosis of autism spectrum disorder (ASD) remains a persistent pediatric health problem, due to limited access to competent diagnosticians and tertiary health care. A telemedicine method using a store-and-forward approach presents an opportunity to facilitate early identification and referral for intervention. This study aimed to evaluate the validity of protocol-guided video recording compared with direct assessment (DA) for diagnosing ASD. Children aged 18-30 months with chief complaints of delayed speech or social indifference, and Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) score of more than two were included. Parents were instructed to video record certain scenarios, which were assessed by an experienced professional based on the (DSM-5) checklist for ASD. DAs using DSM-5 criteria were considered to be the gold standard of diagnosis. Diagnostic agreement, sensitivity, specificity, predictive values, and likelihood ratios were calculated to measure diagnostic validity. The diagnostic agreement between the two methods was 82.5%. The sensitivity of video recording for diagnosing ASD was 91.3% (95% confidence interval [CI] [79.7%-100%]), while the specificity was 70.6% (95% CI [48.9%-92.2%]). The positive predictive value was 80.7% (95% CI [65.6%-95.9%]), while the negative predictive value was 85.7% (95% CI [67.4%-100%]). The positive likelihood ratio was 3.1 (95% CI [1.47-6.5]), while the negative likelihood ratio was 0.16 (95% CI [0.03-0.47]). A telemedicine approach using protocol-guided video recording evaluation has substantial validity compared with DA for diagnosing ASD.
由于获得合格诊断医生和三级医疗保健的机会有限，自闭症谱系障碍（ASD）的延迟诊断仍是一个持续存在的儿科健康问题。一种采用存储转发方法的远程医疗方法为促进早期识别和干预转诊提供了契机。本研究旨在评估与直接评估（DA）相比，方案指导视频记录用于诊断ASD的有效性。纳入年龄在18至30个月、主要表现为语言发育迟缓或社交淡漠且改良版幼儿自闭症检查表（修订版）（M-CHAT-R）得分超过两分的儿童。指导家长对某些场景进行视频记录，由一名经验丰富的专业人员根据ASD的《精神疾病诊断与统计手册》第五版（DSM-5）检查表进行评估。使用DSM-5标准的直接评估被视为诊断的金标准。计算诊断一致性、敏感性、特异性、预测值和似然比以衡量诊断有效性。两种方法之间的诊断一致性为82.5%。视频记录诊断ASD的敏感性为91.3%（95%置信区间[CI][79.7%-100%]），而特异性为70.6%（95%CI[48.9%-92.2%]）。阳性预测值为80.7%（95%CI[65.6%-95.9%]），而阴性预测值为85.7%（95%CI[67.4%-100%]）。阳性似然比为3.1（95%CI[1.47-6.5]），而阴性似然比为0.16（95%CI[0.03-0.47]）。与直接评估相比，采用方案指导视频记录评估的远程医疗方法在诊断ASD方面具有较高的有效性。
