Goyen Traci-Anne, Morgan Catherine, Crowle Cathryn, Hardman Caroline, Day Rosemary, Novak Iona, Badawi Nadia
Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.
Cerebral Palsy Alliance Research Institute, Sydney University, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2020 Sep;56(9):1414-1418. doi: 10.1111/jpc.14953. Epub 2020 Aug 7.
We previously reported sensitivity and specificity levels of the general movements assessment (GMA) to detect cerebral palsy (CP) at 1 year within a clinical setting and with the assistance of the New South Wales (NSW) Rater Network. The aim of this study was to determine whether similarly high levels of validity could be maintained in the same group at 2 years.
A prospective longitudinal cross-sectional study was conducted. GMA was blind-rated from conventional video by two independent certified raters, blinded to medical history. A third rater resolved disagreements. High-risk population screening for CP using the GMA during the fidgety period (12-20 weeks) was carried out in four neonatal intensive care units and one CP service over a 30-month period. Participants were 259 high-risk infants for the initial study. Multidisciplinary follow-up at 2-3 years included Bayley Scales of Infant Development and confirmed diagnosis of CP. Sensitivity and specificity values were calculated with true positives defined as a confirmed diagnosis of CP.
At 2-3 years, 184 (71%) completed the follow-up assessment. GMA was normal for 134 (73%, low risk for CP), absent fidgety for 48 (26%, high risk for CP) and abnormal fidgety for 2 (1%, high risk for abnormal neurological disorder). Sensitivity for detecting CP was 97.6% (40/41) and specificity 95.7% (133/139). Sensitivity for detecting any abnormal outcome with absent/abnormal fidgety general movements (GMs) was 57.9% (44/76) and specificity 94.4% (101/107).
Excellent levels of sensitivity and specificity of the GMA for detecting CP in the clinical setting were maintained at 2 years and were similar to our previously reported findings.
我们之前报告了在临床环境中并借助新南威尔士州（NSW）评估员网络，一般运动评估（GMA）在1岁时检测脑瘫（CP）的敏感性和特异性水平。本研究的目的是确定在同组人群中2岁时是否能维持同样高的有效性水平。
进行了一项前瞻性纵向横断面研究。由两名独立的经过认证的评估员对常规视频进行盲法评分，他们对病史不知情。第三名评估员解决分歧。在30个月的时间里，在四个新生儿重症监护病房和一个脑瘫服务机构对处于不安运动期（12 - 20周）的高危人群进行了使用GMA的CP筛查。最初研究的参与者为259名高危婴儿。2 - 3岁时的多学科随访包括贝利婴儿发育量表，并确诊CP。敏感性和特异性值的计算中，真阳性定义为确诊CP。
在2 - 3岁时，184名（71%）完成了随访评估。GMA正常的有134名（73%，CP低风险），不安运动缺失的有48名（26%，CP高风险），不安运动异常的有2名（1%，神经功能障碍异常高风险）。检测CP的敏感性为97.6%（40/41），特异性为95.7%（133/139）。检测不安运动缺失/异常的一般运动（GMs）出现任何异常结果的敏感性为57.9%（44/76），特异性为94.4%（101/107）。
在临床环境中，GMA检测CP的敏感性和特异性在2岁时维持了优秀水平，且与我们之前报告的结果相似。
