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An effective community-based approach to the identification of neurodevelopmental delay in childhood
E Tirosh1, M Lechtman, H Diamand
1Hanne Khoushi Child Development Center, Paediatric Department, Haifa, Israel.
Insights
Specially trained developmental nurses (DNs) improved developmental screening accuracy in well-baby units. Their assessment significantly reduced unnecessary referrals to the Child Development Centre (CDC), enhancing efficiency.
Area of Science:
- Pediatrics
- Developmental Pediatrics
- Nursing Science
Background:
- Accurate developmental screening is crucial for early intervention in children.
- Well-baby units often face challenges in precise developmental assessment.
- The role of specialized nurses in improving screening accuracy requires investigation.
Purpose of the Study:
- To evaluate the impact of developmental nurses (DNs) on the accuracy of developmental screening.
- To assess the effectiveness of DNs in identifying children needing referral to the Child Development Centre (CDC).
- To determine the false-positive and false-negative rates associated with DN-led screening.
Main Methods:
- A cohort of 13,580 children aged 2-48 months was screened in well-baby units.
- Developmental nurses (DNs) provided secondary assessment for children flagged as 'questionable' for developmental delay.
- Follow-up assessments were conducted at 12 months to verify referrals.
Main Results:
- DN assessment reduced the referral rate from the 'questionable' group to 31% requiring Child Development Centre (CDC) referral.
- The false-positive rate for DN recommendations was 60%, and the false-negative rate was 20%.
- Overall screening accuracy showed a 1.2% false-positive rate and a 6% false-negative rate for the entire cohort.
Conclusions:
- Developmental nurses (DNs) enhance the accuracy of developmental screening in well-baby settings.
- Implementing DNs can optimize referral pathways to the Child Development Centre (CDC), reducing unnecessary consultations.
- This model offers potential economic and clinical benefits for pediatric developmental surveillance.
Abstract:
The contribution of specially trained developmental nurses (DNs) to the accuracy of developmental screening in well-baby units was assessed. Of 13,580 children between two and 48 months of age, the well-baby clinic identified definitive developmental delay in 310, and 357 children were classified as 'questionable'. After DN assessment at 12 months follow-up, only 31 per cent of the questionable group required referral to the Child Development Centre (CDC). Comparison of the original queried recommendations to the CDC with the DN's recommendation indicated a false-positive and -negative rate of 60 and 20 per cent, respectively. This procedure resulted in false-positive and -negative screening accuracies of 1.2 and 6 per cent, respectively, for the total cohort of children screened. The economic and clinical advantages of this model are discussed.