Clinical practice guidelines for monitoring children's behavioural development at the 18-month well-baby visit: A decision analysis comparing the expected benefit of two alternative strategies.

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Clinical Guidelines
Authored By
Baillargeon RH
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Interests
Psychiatry
Pediatric Medicine
Speciality
Pediatric Medicine
Psychiatry
Book Detail
volume
27
ISSN
1365-2753
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ISSN
1365-2753
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true
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Additional Info
["Baillargeon RH","Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9609066 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2753 (Electronic) Linking ISSN: 13561294 NLM ISO Abbreviation: J Eval Clin Pract Subsets: MEDLINE","Journal Article","2021-02-01","Journal of evaluation in clinical practice [J Eval Clin Pract] 2021 Feb; Vol. 27 (1), pp. 62-68. Date of Electronic Publication: 2020 Mar 09.","English","1365-2753","Mass Screening* , Parents*, Child ; Decision Support Techniques ; Humans ; Infant ; Referral and Consultation","Child, Decision Support Techniques, Humans, Infant, Referral and Consultation, Mass Screening, Parents","Journal of evaluation in clinical practice","27"]
Description
Rationale, Aims and Objectives: The current American Academy of Pediatrics policy calls for universal developmental screening (UDS) at the 18-month well-baby visit (18MWBV). In contrast, different clinical practice guidelines exist in other developed countries where only toddlers of concerned parents are referred for (selective) developmental screening (SDS). This study compares the expected benefit (EB) of these two strategies for monitoring children's behavioural development at the 18MWBV.<br />Method: A clinical decision analysis was performed, with EB defined as gain (probability of screening when appropriate + probability of not screening when appropriate) minus cost (probability of screening when not appropriate + probability of not screening when not appropriate). Accordingly, a strategy's EB referred to its efficiency at distinguishing between toddlers who need to be referred for screening and those who do not.<br />Results: The EB of the UDS strategy was estimated at -0.242. In contrast, the EB of the SDS strategy was much greater at 0.326. In fact, the EB of the UDS strategy could only equal or surpass that of the SDS strategy if screening toddlers with a problem was considered almost five times more important than not screening well toddlers. However, our monitoring effort should be more evenly distributed between these two imperatives. Also, the evidence in favour of the SDS strategy remained largely unchanged after considering a broad range of values for the (unique) probabilities in the decision tree.<br />Conclusion: There are many steps involved in the monitoring of children's early behavioural development, but when it comes to decide whether or not to use behavioural screening, there is evidence for adopting the SDS strategy, and screening only if a behavioural concern is being raised by parents.<br /> (© 2020 John Wiley & Sons, Ltd.)
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