Damian McNamara

October 29, 2013

ORLANDO, Florida — A computer-aided screening system for infants flags developmental delays significantly sooner than if screening is based on conversations between pediatricians and parents, according to a new study. Rates of detection did not differ, however.

"The most interesting finding is that kids with developmental delay were identified 8 months earlier — that's big. For some of these kids, 8 months is about a third of their lives," Stephen Downs, MD, from the Indiana University School of Medicine in Indianapolis, told Medscape Medical News.

Dr. Downs presented the findings here at the American Academy of Pediatrics 2013 National Conference and Exhibition.

His team developed a clinical decision support system called Child Health Improvement Through Computer Automation (CHICA). The electronic health records-based system was developed to address multiple facets of well-child care. To date, they have used CHICA to screen approximately 36,000 infants.

Because there is little standardization in the approach pediatricians use to screen and diagnose developmental delays, they recently added a module to CHICA to assist screening for developmental delays using an American Academy of Pediatrics Developmental Screening Guidelines algorithm.

 
The most interesting finding is that kids with developmental delay were identified 8 months earlier — that's big.
 

Given an estimated developmental delay prevalence of 12% to 16% among children in the United States, early and accurate detection is important. "Fewer than half of the kids who have developmental delays have been detected by the time they hit school. By then, you've missed a big opportunity to help these kids out," Dr. Downs said.

The researchers conducted a study to compare the efficacy of the new CHICA module with the current standard of care.

The CHICA screening process begins with a 20-item tailored health questionnaire for the family to complete in the waiting room at each clinic visit. At each visit, parents are asked if they have any concerns about developmental delay. With the new module, an Ages-and-Stages Questionnaire is automatically administered at 9-, 18-, and 30-month clinic visits, or whenever the family expresses a specific concern about development. Responses are optically scanned and physicians receive a write-up identifying up to 6 concerns.

Dr. Downs and his associates compared patient charts from 2 clinics that were using the new CHICA module with charts from 2 matched control clinics using CHICA without the module. They assessed rates of structured developmental screening and average age of diagnosis of developmental delays using single-blinded manual chart abstraction.

Researchers evaluated 360 charts, 180 patients from each setting, for children younger than 3 years of age. The average age of developmental delay diagnosis was a 7.65 months earlier in the computer-aided screening group than in the control group; the difference was statistically significant (= .02).

Table. Computer-Aided vs Standard Developmental Delay Screening

Outcome Computer-Aided Screening Standard Screening
Structured development screening (%) 85 24
Likelihood of screening (adjusted odds ratio) 16 reference
Developmental delay detection (%) 11 7

 

"It's not surprising that clinicians in the intervention group were about 3 times more likely to do developmental screening in eligible kids," said Dr. Downs.

Asked by Medscape Medical News to comment on this study, Christoph Lehmann, MD, from Vanderbilt University Medical Center in Nashville, Tennessee, said that "this study is very interesting and noteworthy. It shows that all kids with disabilities eventually do get diagnosed, but if you use the new CHICA module, the diagnosis is made much earlier."

Earlier identification translates into more time to determine resources, start interventions, and work with providers and families, he added.

"It will be interesting to see if outcomes improve once they have a larger cohort of individuals with delay," said Dr. Lehmann. "What makes me sad about this study is that this is something only a place like Indiana University, where they have the tools to develop these things in-house and are not dependent on an electronic health record vendor, can do."

Dr. Downs said he hopes to expand the use of CHICA in the future. "CHICA is only in our hospital now, but we hope to deploy it to other centers nationwide. In the long term, we want to build a Web server that can be connected to any commercial electronic health record nationwide."

Dr. Downs and Dr. Lehmann have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2013 National Conference and Exhibition: Abstract 31. Presented October 25, 2013.

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