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Misclassification in defining and diagnosing microcephaly.

Mariah M Kalmin1, Emily W Gower1, Elizabeth M Stringer2

  • 1Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina.

Paediatric and Perinatal Epidemiology
|July 27, 2019
PubMed
Summary
This summary is machine-generated.

Simple head circumference cut-offs for diagnosing microcephaly (a small head size) may lead to inaccurate prevalence estimates, especially in Zika virus-affected regions. This highlights the need for clearer diagnostic criteria beyond simple measurements.

Keywords:
Zika virusepidemiologymicrocephalymisclassification

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Area of Science:

  • Medical surveillance
  • Pediatric neurology
  • Infectious disease epidemiology

Background:

  • Health agencies often define microcephaly using a single head circumference percentile or Z-score for surveillance.
  • This definition conflicts with observed microcephaly prevalence, even in Zika virus-endemic areas.

Purpose of the Study:

  • Investigate discrepancies between simple microcephaly definitions and reported prevalence.
  • Explore potential misclassification due to differing diagnostic criteria.
  • Assess the impact of using percentile cut-offs with low prevalence estimates.

Main Methods:

  • Conducted simulations using a theoretical bimodal head circumference distribution.
  • Calculated sensitivity and specificity for various head circumference cut-offs.
  • Determined and plotted positive predictive values based on microcephaly prevalence.

Main Results:

  • Simulations indicate that cut-off-based definitions yield poor positive predictive values under realistic prevalence conditions.
  • The findings suggest potential overestimation of microcephaly prevalence when relying solely on head circumference thresholds.

Conclusions:

  • Simple head circumference criteria for microcephaly lack clarity for diagnosing pathological cases.
  • These definitions can cause confusion regarding true microcephaly prevalence in Zika-endemic regions.
  • Potential for bias in etiological studies due to imprecise diagnostic criteria.