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Four key questions that identify severe disability
1National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford, UK.
Insights
A brief health questionnaire can effectively identify severe childhood disability. This method aids in understanding the prevalence of severe disability in children, improving early detection and intervention strategies.
Area of Science:
- Pediatrics
- Neonatal care
- Disability assessment
Background:
- A study involving 604 children assessed for disability at age 2.
- Children were part of a neonatal trial on fresh frozen plasma's effect on intraventricular hemorrhage.
- Disability categorization was based on pediatric assessment and a 29-item health visitor questionnaire.
Purpose of the Study:
- To determine if severe childhood disability can be identified using a minimal subset of questions.
- To assess the feasibility of using a short questionnaire for disability screening.
Main Methods:
- Sensitivity and specificity analysis of individual questionnaire items to identify key questions.
- Validation of the four most effective questions in a separate cohort of 105 children.
- Comparison of questionnaire-based disability identification with expert pediatric assessment.
Main Results:
- In the initial cohort, four questions correctly identified 56 out of 61 severely disabled children, with 7 false positives.
- In the validation cohort, the four questions correctly identified 6 out of 7 severely disabled children, with no false positives.
- The selected questions demonstrated high accuracy in identifying severe disability.
Conclusions:
- A short, four-question screening tool shows promise for identifying severe childhood disability.
- Incorporating these questions into routine child health systems could provide valuable prevalence data.
- This approach may facilitate early identification and management of childhood disabilities.
Background:
Six hundred and four surviving children aged 2 years, who had been entered into a neonatal trial of fresh frozen plasma on the incidence of intraventricular haemorrhage, were grouped into four categories of disability based on a review by a full paediatric assessment. A 29 item questionnaire completed by the children's health visitors was used to group the children into the same categories.
Aims:
To explore whether severe disability could be identified by using only a few of the 29 questions.
Method:
The sensitivity and specificity of individual questions were used first to find the subset of questions that best identified children with severe disability. The efficacy of the four most useful questions was tested in a separate cohort of 105 children for whom health visitors had completed questionnaires at the age of 2 years, and who had similarly been assessed by a paediatrician.
Results:
In the original trial cohort, the four questions correctly identified 56 of the 61 children with the most severe disabilities as assessed by the paediatrician, and seven children were falsely identified as being severely disabled. In the second cohort, the four questions correctly identified six of the seven children classified as severely disabled by the paediatrician, with no false positives.
Conclusion:
If four such questions were included in routine child information systems at age 2 years, it might be possible to obtain useful data on the prevalence of severe disability in children.