Primary Care Providers' Initial Evaluation of Children with Global Developmental Delay: A Clinical Vignette Study.
Primary Care Providers' Initial Evaluation of Children with Global Developmental Delay: A Clinical Vignette Study.
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初级保健提供者对整体发育迟缓儿童的初步评估：临床小插图研究。
DOI：
10.1016/j.jpeds.2015.08.065
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Uhlmann,WendyR
中科院分区：
文献类型：
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作者：
Tarini,BethA;Zikmund-Fisher,BrianJ;Saal,HowardM;Edmondson,Laurie;Uhlmann,WendyR
目的检查儿科初级保健医生对疑似整体发育迟缓 (GDD) 儿童的诊断评估的决定。研究设计将一项调查邮寄给从美国医学会医师主档案中随机选择的儿科医生 (n = 600) 和家庭医生 (n = 600) 样本。该调查包含一个临床小插曲，描述了一名患有 GDD 的 9 个月大的非畸形男孩。参与者被问及他们的初始评估步骤（测试、转介或测试和转介两者）以及他们将寻求什么类型的转介和/或测试。我们检查了医生/临床实践特征与参与者评估决策之间的双变量关联。结果完成调查的儿科医生多于家庭医生（答复率：55% vs 38%）。近四分之三的受访者 (74%) 表示，他们诊断评估的第一步是转介孩子而不进行测试，22% 的受访者只会进行测试，4% 的人会同时进行测试和转介。作为第一步，大多数医生会求助于发育儿科医生 (58%)，只有 5% 会求助于遗传学家。最常见的测试是一般生化测试（64%）。最常见的基因检测是核型检测（39%）。 结论 在评估患有 GDD 的儿童时，很少有初级保健医生会要求进行基因检测或请遗传学专家作为第一个评估步骤。未来的研究应该探讨对 GDD 儿童进行基因评估的障碍和利用。
ObjectiveTo examine the decisions of pediatric primary care physicians about their diagnostic evaluation for a child with suspected global developmental delay (GDD).Study designA survey was mailed to a sample of pediatricians (n = 600) and family physicians (n = 600) randomly selected from the American Medical Association Physician Masterfile. The survey contained a clinical vignette describing a 9-month-old nondysmorphic boy with GDD. Participants were asked their initial evaluation steps (test, refer, or both test and refer) and what types of referral and/or testing they would pursue. We examined bivariate associations between physician/clinical practice characteristics and participants' evaluation decision.ResultsMore pediatricians than family physicians completed the survey (response rates: 55% vs 38%). Almost three-quarters of the respondents (74%) reported that their first step in a diagnostic evaluation would be to refer the child without testing, 22% would test only, and 4% would both test and refer. As their initial step, most physicians referred to a developmental pediatrician (58%), and only 5% would refer to a geneticist. The most commonly ordered test was general biochemical testing (64%). The most commonly ordered genetic test was a karyotype (39%).ConclusionsWhen evaluating a child with GDD, few primary care physicians would order genetic testing or refer to a genetics specialist as a first evaluation step. Future studies should examine both barriers to and utilization of a genetic evaluation for children with GDD.
美国神经病学学会和全球发育迟缓小组委员会：质量标准报告证据报告：儿童遗传和代谢测试
DOI：
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发表时间：
--
期刊：
影响因子：
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作者：
D. Michelson;M. Shevell;E. Sherr
通讯作者：
E. Sherr
影响因子：
8
作者：
Moeschler, John B.;Shevell, Michael
通讯作者：
Shevell, Michael