We established the validity of the jaundice colour card as a parental measurement tool for jaundice in Chinese neonates, and the cheek was the best measurement site.
BackgroundSince most infants are usually discharged before age 48–72 hours, peak bilirubin levels will almost always occur after discharge. Parents may be the first to observe the onset of jaundice after discharge, but visual assessment is unreliable. The jaundice colour card (JCard) is a low-cost icterometer designed for the assessment of neonatal jaundice. The objective of this study was to evaluate parental use of JCard to detect jaundice in neonates.MethodsWe conducted a multicentre, prospective, observational cohort study in nine sites across China. A total of 1161 newborns ≥35 weeks of gestation were enrolled in the study. Measurements of total serum bilirubin (TSB) levels were based on clinical indications. The JCard measurements by parents and paediatricians were compared with the TSB.ResultsJCard values of parents and paediatricians were correlated with TSB (r=0.754 and 0.788, respectively). The parents’ and paediatricians’ JCard values 9 had sensitivities of 95.2% vs 97.6% and specificities of 84.5% vs 71.7% for identifying neonates with TSB ≥153.9 µmol/L. The parents’ and paediatricians’ JCard values 15 had sensitivities of 79.9% vs 89.0% and specificities of 66.7% vs 64.9% for identifying neonates with TSB ≥256.5 µmol/L. Areas under the receiver operating characteristic curves of parents for identifying TSB ≥119.7, ≥153.9, ≥205.2, and ≥256.5 µmol/L were 0.967, 0.960, 0.915, and 0.813, respectively, and those of paediatricians were 0.966, 0.961, 0.926 and 0.840, respectively. The intraclass correlation coefficient was 0.933 between parents and paediatricians.ConclusionThe JCard can be used to classify different levels of bilirubin, but it is less accurate with high bilirubin levels. The JCard diagnostic performance of parents was slightly lower than that of paediatricians.
An SR is a methodologically-rigorous overview of the medical literature designed to answer a specific clinical question. SRs typically attempt to answer therapeutic questions. However, diagnostic test questions and other study designs may also be the basis for an SR. In the hierarchy of the EBM pyramid, the clinical utility of an SR stands above the clinical utility of individual studies, especially if the SR is based on methodologically high-quality studies (eg, randomized, controlled trials). A key distinguishing feature of an SR compared with a standard, or traditional, review, is that an SR has a methods section. Both types of reviews have their place in informing clinical practice. However, it is likely a safer bet to base a clinical decision on the results of an SR. The basic methodologic validity issues of an SR may be minimally assessed through 3 questions: 1) Did the SR address a focused clinical question?; 2) Were the criteria used to select articles for inclusion appropriate (ie, were the individual studies used in the SR of high methodological quality, eg, randomized, controlled trials)?; and 3) Is it unlikely that important, relevant studies were missed (ie, was an exhaustive search performed to identify all available relevant studies)? In the next EBM Pearl, we will discuss the basic approach to assessing the results of an SR.
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