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Detection of Speech-Language Delay in the Primary Care Setting: An Electronic Health Record Investigation
Catherine Frelinger1, Rebecca M Gardner2, Lynne C Huffman1
1Division of Developmental and Behavioral Pediatrics, Stanford University School of Medicine, Stanford, CA.
Insights
Speech-language delay affects 14.1% of young children, with identification rates similar to national averages. Males and publicly insured children are more likely to be diagnosed, while females and privately insured children are identified later.
Area of Science:
- Pediatric primary care
- Speech-language pathology
- Public health
Background:
- Early identification of speech-language delay is crucial for timely intervention.
- Sociodemographic factors may influence the detection rates and age of diagnosis.
- Understanding these disparities is essential for equitable healthcare delivery.
Purpose of the Study:
- To determine the incidence of speech-language delay in a pediatric primary care network.
- To examine the age of first identification of speech-language delay.
- To investigate the relationship between child sociodemographic variables and speech-language delay identification.
Main Methods:
- Analysis of deidentified electronic health records from 14,559 children aged 1-5 years (2015-2019).
- Utilized ICD-10 codes for speech-language delay diagnosis.
- Employed regression models to assess associations with patient characteristics, adjusting for practice affiliation.
Main Results:
- 14.1% of children (2063/14,559) were diagnosed with speech-language delay.
- Males (aOR=2.05) and publicly insured children (aOR=1.48) had higher odds of identification.
- Females and privately insured children were identified at older ages.
Conclusions:
- Speech-language delay identification rates in this network align with national prevalence.
- Further research is needed to explore detection differences across patient subgroups and screening methods.
- Optimizing developmental screening and surveillance can improve early identification.
Objective:
The purpose of this study is to determine the rate and age at first identification of speech-language delay in relation to child sociodemographic variables among a pediatric primary care network.
Methods:
We analyzed a deidentified data set of electronic health records of children aged 1- to 5-years-old seen between 2015 and 2019 at 10 practices of a community-based pediatric primary health care network. Primary outcomes were numbers (proportions) of patients with relevant ICD-10 visit-diagnosis codes and patient age (months) at first documentation of speech-language delay. Regression models estimated associations between outcomes and patient characteristics, adjusting for practice affiliation.
Results:
Of 14,559 included patients, 2063 (14.1%) had speech-language delay: 68.4% males, 74.4% with private insurance, and 96.1% with English as a primary household language. Most patients (60%) were first identified at the 18- or 24-month well-child visit. The mean age at first documentation was 25.4 months (SD = 9.3), which did not differ between practices reporting the use of standardized developmental screener and those using surveillance questionnaires. Regression models showed that males were more than twice as likely than females to be identified with speech-language delay (adjusted odds ratio [aOR] = 2.05, 95% CI: [1.86-2.25]); publicly insured were more likely than privately insured patients to be identified with speech-language delay (aOR = 1.48, 95% CI: [1.30-1.68]). Females were older than males at first identification (+1.2 months, 95% CI: [0.3-2.1]); privately insured were older than military insured patients (private +3.3 months, 95% CI: [2.2-4.4]).
Conclusion:
Pediatricians in this network identified speech-language delays at similar rates to national prevalence. Further investigation is needed to understand differences in speech-language delay detection across patient subgroups in practices that use developmental screening and/or surveillance.
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