系统评价和荟萃分析：儿童发育筛查测试的真实世界准确性。

Systematic Review and Meta-analysis: Real-World Accuracy of Children's Developmental Screening Tests.

机构信息

Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Seoul National University Hospital, Seoul, Republic of Korea.

出版信息

J Am Acad Child Adolesc Psychiatry. 2023 Oct;62(10):1095-1109. doi: 10.1016/j.jaac.2022.12.014. Epub 2022 Dec 30.

DOI:10.1016/j.jaac.2022.12.014

PMID:36592715

Abstract

OBJECTIVE

This review presents a list of developmental screening tests used in clinical settings worldwide and provides a broad estimate of their accuracy (PROSPERO: CRD42021236474).

METHOD

Following the PRISMA Diagnostic Test Accuracy (DTA) guidelines, this review involved searching PubMed, PsycINFO, Cochrane, EMBASE, CINAHL, and Google Scholar (for manual searching). Inclusion criteria included studies published in English through 2020 that compared the accuracy of developmental screening tests against developmental diagnostic tests among children under 13 years of age. Six researchers, in pairs, independently selected the studies and extracted the data. A hierarchical model was applied to meta-analyze the diagnostic accuracy of the tests, and meta-regression was used to identify the moderators using R 4.1.3 software.

RESULTS

The meta-analysis included 56 studies (17 screening tests and 61 outcomes). The most frequently used screening tests were the Ages and Stages Questionnaire (ASQ), Denver Developmental Screening Test (DDST), and Parent's Evaluation of Developmental Status (PEDS). The pooled sensitivity and specificity were 0.75 (95% CI = 0.69-0.80) and 0.76 (95% CI = 0.71-0.80), and the overall diagnostic accuracy of the total outcomes (area under the curve) was 0.80. High heterogeneity was observed between the included studies with various thresholds of the tests. Participants' developmental concerns at the baseline significantly moderated the accuracy of the screening tests, resulting in double the positive predictive value and prevalence compared to those without the concerns.

CONCLUSION

We recommend a standardized process of validation studies for diagnostic accuracy, to ensure the effectiveness of developmental screening tests in clinical settings.

STUDY PREREGISTRATION INFORMATION

Accuracy of Developmental Screening Tools among Children in Real World: a Systematic Review and Meta Analysis; https://www.crd.york.ac.uk/; CRD42021236474.

摘要

目的

本综述列出了全球临床环境中使用的发育筛查测试，并提供了对其准确性的广泛估计（PROSPERO：CRD42021236474）。

方法

根据 PRISMA 诊断测试准确性（DTA）指南，本综述涉及在 PubMed、PsycINFO、Cochrane、EMBASE、CINAHL 和 Google Scholar 中进行搜索（手动搜索）。纳入标准包括通过 2020 年发表的英文研究，比较了 13 岁以下儿童的发育筛查测试与发育诊断测试的准确性。六名研究人员两两独立选择研究并提取数据。使用 R 4.1.3 软件应用分层模型对测试的诊断准确性进行荟萃分析，并使用元回归识别调节因素。

结果

荟萃分析包括 56 项研究（17 项筛查测试和 61 项结果）。最常用的筛查测试是年龄与阶段问卷（ASQ）、丹佛发育筛查测试（DDST）和父母发育状况评估（PEDS）。汇总的敏感性和特异性分别为 0.75（95%CI=0.69-0.80）和 0.76（95%CI=0.71-0.80），总结果（曲线下面积）的总体诊断准确性为 0.80。纳入的研究之间存在高度异质性，测试的各种阈值存在差异。参与者在基线时的发育问题显著调节了筛查测试的准确性，导致阳性预测值和患病率是没有这些问题的两倍。