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Published on: August 25, 2014
Screening for developmental delay in high-risk users of an urban pediatric emergency department
Devin S Grossman1, Alan L Mendelsohn, Michael G Tunik
1New York University School of Medicine, New York, NY, USA. devin.grossman@gmail.com
Insights
Routine developmental screening in pediatric emergency departments (PEDs) can identify undiagnosed developmental delays in young children. This study found nearly 30% of children aged 6-36 months screened positive for potential delays, highlighting the PED
Area of Science:
- Pediatric Emergency Medicine
- Developmental Pediatrics
- Public Health
Background:
- Early identification of developmental delay is crucial for timely intervention.
- Pediatric emergency departments (PEDs) serve a diverse population, including those without consistent primary care.
Purpose of the Study:
- To assess the effectiveness of screening for undiagnosed developmental delay in children aged 6 to 36 months within an urban PED setting.
Main Methods:
- A cross-sectional study involving 138 children (6-36 months) presenting to an urban PED.
- Developmental screening was conducted using the Ages and Stages Questionnaire (ASQ) assessing communication, motor, problem-solving, and personal-social domains.
- Sociodemographic data and primary care access were collected.
Main Results:
- 26.8% of children screened positive for potential developmental delay in at least one ASQ domain.
- Children aged 12-30 months had significantly higher odds of a positive screen (AOR=8.4).
- Having a primary caregiver born in the U.S. was associated with a statistically significant increased odds of positive screening (P=0.03).
Conclusions:
- Routine developmental screening in urban PEDs can identify a substantial proportion of children with previously undiagnosed developmental delays.
- The PED setting may serve as a valuable point for developmental screening, particularly for children lacking regular primary care.
- Further research is recommended to evaluate the feasibility and impact of implementing such screening programs in PEDs.
Objective:
To determine whether screening children in an urban pediatric emergency department (PED) would lead to identification of previously undiagnosed developmental delay.
Methods:
This was a cross-sectional study of families presenting to an urban public hospital PED with children 6 to 36 months and no history of developmental delay. Children were screened for possible developmental delay using the Ages and Stages Questionnaire; parents completed an instrument that assesses 5 domains: communication, gross motor, fine motor, problem solving, and personal-social. Sociodemographic data were also obtained.
Results:
One hundred thirty-eight children were enrolled, all accompanied by their mothers. Mean age of the children was 18.9 months; 51.5% were female; 56.8% of the mothers were high-school graduates; 59.9% were immigrants; 75.4% were Latino. Twenty-one percent did not have a regular source of primary care; 26.8% (95% confidence interval, 20.1%-34.8%) screened positive in at least 1 domain, with a trend toward the highest percentage of positive screens on the communication domain (z = 1.89, P = 0.059). In a simultaneous multiple logistic regression model including all predictor variables, child age of 12 to 30 months was associated with increased adjusted odds of positive screen (adjusted odds ratio, 8.4; 95% confidence interval, 1.4-48.9). Having a primary caregiver born in the United States was statistically significant for screening positive in at least 1 Ages and Stages Questionnaire domain (P = 0.03).
Conclusions:
Almost 30% of 6- to 36-month-old children presenting to an urban PED without prior developmental concerns screened positive for possible delay, suggesting the utility of performing routine developmental screening in the PED. Pediatric emergency department use alone may be an indication for screening. Further study is needed for feasibility of screening for delay in the PED.
