The Screening Hand Assessment for Infants for detecting the risk of unilateral cerebral palsy: Item selection and
Ulrike C Ryll1, Johanna Kembe1, Cornelia H Verhage2
1Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
Insights
A new screening tool, the screening Hand Assessment for Infants (s-HAI), can identify infants at high risk for unilateral cerebral palsy (CP) from 3.5 months old. This tool shows potential for early detection and intervention in infants.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Clinical Assessment Tools
Background:
- Early detection of unilateral cerebral palsy (CP) is crucial for timely intervention.
- Current screening methods may not be optimized for very young infants.
- The Hand Assessment for Infants (HAI) is a comprehensive tool, but a shorter version is needed for screening.
Purpose of the Study:
- To develop and validate a brief screening tool, the screening Hand Assessment for Infants (s-HAI), for identifying infants at high risk of unilateral CP.
- To select optimal items from the HAI for screening infants as young as 3.5 months.
- To determine the sensitivity and specificity of the s-HAI for predicting unilateral CP.
Main Methods:
- Receiver operating characteristic (ROC) curve analysis was used to select items from existing HAI assessments of 212 infants (3.5-8.5 months old).
- The area under the curve (AUC), sensitivity, specificity, and cut-off values were calculated for the selected item combination.
- Infant outcomes (unilateral CP diagnosis at ≥24 months) served as the criterion standard.
Main Results:
- The developed 6-item s-HAI demonstrated strong predictive performance, with AUC values ranging from 0.85 to 0.87 for specific item combinations.
- The s-HAI achieved high sensitivity (88-91%) at proposed cut-off scores (7-8 points) for the contralesional hand score.
- Specificity ranged from 60% to 73%, indicating good accuracy in identifying at-risk infants.
Conclusions:
- The 6-item s-HAI is a promising tool for screening infants from 3.5 months of age for risk of unilateral CP.
- The s-HAI is designed to be easy to administer, time-efficient, and suitable for various clinical settings.
- Further validation in a new dataset is recommended to confirm its measurement properties and feasibility.
Aim:
To develop a screening tool (the screening Hand Assessment for Infants [s-HAI]) for infants aged from 3.5 months that can identify a high risk of developing unilateral cerebral palsy (CP) based on a selection of items from the HAI.
Method:
Receiver operating characteristic curve analysis was performed on previously collected HAI assessments from 212 infants (104 females, 108 males) aged from 3.5 to 8.5 months, to select items suitable for screening. The area under the curve (AUC), sensitivity, specificity, and cut-off values were derived for the suggested item combination. The clinical outcome (unilateral CP yes or no) at 24 months or older served as the external criterion.
Results:
About half of the infants developed unilateral CP. The AUC across the items ranged from 0.63 to 0.80, and from 0.85 to 0.87 for different item combinations. Sensitivity for the selected 6-item set was 91% for 8 points or less and 88% for 7 points or less on the contralesional score of each hand, while specificity was 60% and 73% respectively.
Interpretation:
The s-HAI, designed from six HAI items, has the potential to be used to screen infants at risk of unilateral CP from 3.5 months of age. It is easy to administer, time-efficient, and can be used in different settings. Its measurement properties and feasibility need to be tested in a new data set.
