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Systematic Review and Meta-analysis: Real-World Accuracy of Children's Developmental Screening Tests
Sung Sil Rah1, Minho Jung2, Kyungmin Lee3
1Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
This systematic review evaluated the accuracy of developmental screening tests for children under 13. Overall accuracy was 0.80, with sensitivity and specificity around 0.75, but accuracy varied based on developmental concerns.
Area of Science:
- Pediatric developmental screening
- Diagnostic test accuracy
- Systematic review and meta-analysis
Background:
- Developmental screening tests are crucial for early identification of potential issues in children.
- Existing literature lacks a comprehensive synthesis of the global accuracy of these widely used tools.
- This review addresses the need for evidence-based selection of reliable developmental screening instruments.
Approach:
- A systematic review and meta-analysis adhering to PRISMA Diagnostic Test Accuracy (DTA) guidelines.
- Searched multiple databases (PubMed, PsycINFO, Cochrane, EMBASE, CINAHL, Google Scholar) for studies published up to 2020.
- Included 56 studies comparing screening tests against diagnostic tests in children under 13, analyzing data using hierarchical models and meta-regression.
Key Points:
- The meta-analysis included 56 studies, evaluating 17 distinct developmental screening tests.
- Pooled sensitivity was 0.75 and specificity was 0.76, with an overall diagnostic accuracy (AUC) of 0.80.
- Developmental concerns at baseline significantly moderated test accuracy, doubling positive predictive value.
Conclusions:
- Standardized validation studies are recommended to ensure the effectiveness of developmental screening tests in clinical practice.
- The findings highlight the importance of considering baseline developmental concerns when interpreting screening test results.
- This review provides a broad estimate of accuracy for commonly used developmental screening tools worldwide.
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.
