Williams Sîan A, Mackey Anna, Sorhage Alexandra, Battin Malcolm, Wilson Nichola, Spittle Alicia, Stott N Susan
School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
Department of Surgery, University of Auckland, Auckland, New Zealand.
J Paediatr Child Health. 2021 Apr;57(4):541-547. doi: 10.1111/jpc.15263. Epub 2020 Nov 20.
A diagnosis of cerebral palsy (CP) can, and should, be made as early as possible. This work describes current clinical practice around the awareness and use of diagnostic tools for the detection of CP in New Zealand (NZ).
A purpose-developed survey distributed electronically to NZ clinicians working with young children with or at risk of CP.
A total of 159 clinicians (including paediatricians, physiotherapists and occupational therapists) participated in this cross-sectional study. Ninety-six percent were aware that a diagnosis of CP can be made by 12 months of age, with high levels of awareness of the use of magnetic resonance imaging (94%), Prechtl's qualitative assessment of general movements (GMs) (70%) and Hammersmith Infant Neurological Examination (HINE) (77%). Only 40% were aware of the HINE optimality scoring. Fifty-four clinicians provided a diagnosis of CP as part of their role: 48% never used the GMs or HINE to assess children <1 year, and 57% never used the HINE for children between 1 and 2 years. Clinicians not providing a diagnosis within their professional role (n = 104) also indicated infrequent use of assessment tools with 74% and 54% never using the GM's or HINE (respectively) in their assessment of children at risk of CP. Barriers to use included lack of time and funding, lack of clear pathways and management support.
Despite high awareness, current use of international best practice tools in NZ clinical practice appears low. Multiple barriers are reported to the use of these tools, which need to be addressed to improve the timeliness of diagnosis.
脑性瘫痪（CP）的诊断能够且应该尽早做出。本研究描述了新西兰目前关于CP检测诊断工具的认知和使用情况的临床实践。
专门设计了一项调查问卷，通过电子方式分发给在新西兰从事与患有CP或有CP风险的幼儿相关工作的临床医生。
共有159名临床医生（包括儿科医生、物理治疗师和职业治疗师）参与了这项横断面研究。96%的人知道CP在12个月大时就可以确诊，对磁共振成像（94%）、普雷茨尔的全身运动质量评估（GMs）（70%）和哈默史密斯婴儿神经学检查（HINE）（77%）的使用认知程度较高。只有40%的人知道HINE最优评分。54名临床医生在其工作中做出了CP诊断：48%的人从未使用GMs或HINE评估1岁以下儿童，57%的人从未使用HINE评估1至两岁儿童。不在专业工作中做出诊断的临床医生（n = 104）也表示很少使用评估工具，分别有74%和54%的人在评估有CP风险的儿童时从未使用GMs或HINE。使用障碍包括缺乏时间和资金、缺乏明确的途径和管理支持。
尽管认知度较高，但新西兰临床实践中目前对国际最佳实践工具的使用似乎较低。据报道，使用这些工具存在多种障碍，需要加以解决以提高诊断的及时性。
