Uncertainties regarding cerebral palsy diagnosis: opportunities to operationalize the consensus definition.
Uncertainties regarding cerebral palsy diagnosis: opportunities to operationalize the consensus definition.
复制标题
脑瘫诊断的不确定性：实施共识定义的机会。
DOI：
10.1101/2023.06.29.23292028
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Kruer,Michael
中科院分区：
文献类型：
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作者：
Aravamuthan,BhoomaR;Fehlings,DarcyL;Novak,Iona;Gross,Paul;Alyasiri,Noor;Tilton,Ann;Shevell,Michael;Fahey,Michael;Kruer,Michael
背景和目的脑性瘫痪（脑瘫）是儿童期最常见的运动障碍，常被误诊.我们假设，儿童神经学家和神经发育学家，往往在北美的CP诊断的第一线，从2006.MethodsWe进行了儿童神经学家和神经发育学家在2022年儿童神经病学学会年会的横断面调查的最新CP共识定义的实际应用方面的不确定性。与会者提供了2006年CP共识的定义，并询问他们是否有任何不确定性的实际应用的定义在四个假设的临床vignettes.ResultsOf 230与会者，164回答了结束调查的问题（71%）。145/164（88%）对2006年定义的临床应用表示至少一种不确定性。这些不确定性主要集中在：1）年龄，包括最低诊断年龄和脑功能障碍或运动症状发作的最高年龄（67/164，41%），以及2）术语“非进展性”的解释（48/164，29%）。绝大多数受访者（157/164，96%）对以下问题回答“是”：您认为我们应该修改2006年共识的CP定义吗？讨论我们建议，我们确定的不确定性，可以通过操作2006年的共识定义，以支持一个更统一的CP诊断。为了解决我们发现的最常见的CP诊断不确定性，我们根据现有文献提出了3点澄清：1）运动症状/体征应在2岁时出现; 2）CP可以而且应该尽早诊断，即使活动受限尚未出现，如果运动症状/体征可合理预测为活动受限（例如，通过使用标准化检查仪器、脑MRI和提示性临床病史）;和3）临床运动残疾表型在5岁内应是非进展性的。我们预计，以这种方式实施2006年CP的定义可以澄清我们在儿童神经学家和神经发育学家中发现的不确定性，并减少目前存在的诊断变异性。
Background and ObjectivesCerebral palsy (CP), the most common motor disability of childhood, is variably diagnosed. We hypothesized that child neurologists and neurodevelopmentalists, often on the frontlines of CP diagnosis in North America, harbor uncertainties regarding the practical application of the most recent CP consensus definition from 2006.MethodsWe conducted a cross-sectional survey of child neurologists and neurodevelopmentalists at the 2022 Child Neurology Society Annual Meeting. Attendees were provided the 2006 CP consensus definition and asked whether they had any uncertainties about the practical application of the definition across four hypothetical clinical vignettes.ResultsOf 230 attendees, 164 responded to the closing survey questions (71%). 145/164 (88%) expressed at least one uncertainty regarding the clinical application of the 2006 definition. Overwhelmingly, these areas of uncertainty focused on: 1) Age, both with regards to the minimum age of diagnosis and the maximum age of brain disturbance or motor symptom onset, (67/164, 41%), and 2) Interpretation of the term “non-progressive” (48/164, 29%). The vast majority of respondents (157/164, 96%) answered ‘Yes’ to the question: Do you think we should revise the 2006 consensus definition of CP?DiscussionWe propose that the uncertainties we identified could be addressed by operationalizing the 2006 consensus definition to support a more uniform CP diagnosis. To address the most common CP diagnostic uncertainties we identified, we propose 3 points of clarification based on the available literature: 1) Motor symptoms/signs should be present by 2 years old; 2) CP can and should be diagnosed as early as possible, even if activity limitation is not yet present, if motor symptoms/signs can be reasonably predicted to yield activity limitation (e.g. by using standardized examination instruments, Brain MRI, and a suggestive clinical history); and 3) The clinical motor disability phenotype should be non-progressive through 5 years old. We anticipate that operationalizing the 2006 definition of CP in this manner could clarify the uncertainties we identified among child neurologists and neurodevelopmentalists and reduce the diagnostic variability that currently exists.