Measuring sensorineural disability in preterm children using a public health screening strategy: A randomised controlled trial

Pritchard, Margo A., Colditz, Paul B., Tudehope, David I., Gray, Peter H., Cartwright, David, Wigg, Neil R. and Beller, Elaine M. (2008) Measuring sensorineural disability in preterm children using a public health screening strategy: A randomised controlled trial. Journal of Paediatrics and Child Health, 44 7-8: 424-431. doi:10.1111/j.1440-1754.2008.01323.x


Author Pritchard, Margo A.
Colditz, Paul B.
Tudehope, David I.
Gray, Peter H.
Cartwright, David
Wigg, Neil R.
Beller, Elaine M.
Title Measuring sensorineural disability in preterm children using a public health screening strategy: A randomised controlled trial
Journal name Journal of Paediatrics and Child Health   Check publisher's open access policy
ISSN 1440-1754
Publication date 2008-07-01
Year available 2008
Sub-type Article (original research)
DOI 10.1111/j.1440-1754.2008.01323.x
Open Access Status Not yet assessed
Volume 44
Issue 7-8
Start page 424
End page 431
Total pages 7
Place of publication Oxford, England
Publisher Wiley-Blackwell Publishing Ltd.
Language eng
Subject C1
920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified
111402 Obstetrics and Gynaecology
111401 Foetal Development and Medicine
1114 Paediatrics and Reproductive Medicine
Abstract Aim: To assess the efficacy of a preterm-targeted screening programme against the routine Australian National Health Medical Research Council (NHMRC) universal child health screening programme to detect disability in a general practice setting in children born <= 31 weeks gestation at 12-months of age.
Formatted abstract
Aim:
To assess the efficacy of a preterm-targeted screening programme against the routine Australian National Health Medical Research Council (NHMRC) universal child health screening programme to detect disability in a general practice setting in children born ≤31 weeks gestation at 12-months of age.

Methods:
Multi-centred trial involving 202 preterm children randomised to receive the preterm-targeted or NHMRC programme. Primary outcome, correct identification of neurosensory disability by general practitioners assessed against gold standard paediatric assessments. Sensitivity analysis estimated interrater agreement and screening accuracy. Secondary outcomes, post natal depression (PND), parental stress, health service use, screening programme helpfulness and correct identification of levels of disability severity.

Results:
Of the 195 infants with data on the primary outcome in the preterm-targeted group, their general practitioners correctly identified the disability status of 61/93 (65.6%) children, as compared with 69/102 (67.6%) in the NHMRC group (odds ratios (OR) 0.91 95% confidence interval (CI) 0.50, 1.65). Responses where general practitioners were unsure of a child's disability status were coded as incorrect and not paired for sensitivity analysis. Sensitivity analysis for 180 diagnostic pairs showed fair interrater agreement for both groups (preterm-targeted k = 0.30 vs. NHMRC k = 0.29) with screening test results favouring the preterm-targeted group with greater sensitivity (73% vs. 33%) but lower specificity (70% vs. 92%) resulting in more over referrals (30% vs. 8%); however, these had a significantly lower mean Developmental Quotient (DQ) score compared with non-disabled children. PND scores were higher in preterm-targeted group (OR 1.33 95% CI 0.01, 2.66).

Conclusion:

The preterm-targeted programme used by general practitioners: (i) did not improve overall identification of disability status compared to the NHMRC universal programme (Australian New Zealand Clinical Trails Registry number, ACTRN 12606000472572); however (ii) it did demonstrate greater efficacy as a screening tool in accurately identifying disabled children.
Keyword Neurosensory
Preterm
Primary-health
Randomised
Targeted-screening
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

 
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Created: Mon, 30 Mar 2009, 00:31:43 EST by Amanda Barnett on behalf of Faculty Of Health Sciences