Investigation of developmental delay

Goede, Christian de; Myers, Martin; Oakey, Jane

doi:10.1136/archdischild-2017-314569

Cited by 2 publications

(6 citation statements)

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“…This agrees with other groups’ work [ 1 , 5 , 14 , 29 – 31 ]. However, other publications extol the importance of diagnosing metabolic disorders, [ 20 , 21 , 23 , 32 – 34 ] particularly where they are treatable. Such divergence in views was also seen amongst our participants.…”

Section: Discussionmentioning

confidence: 99%

“…The criticism we faced when recommending reducing amounts of investigations in EDI guidelines [ 23 ] was valid in many ways, including the observation that not every child in our cohort received the same investigations. In reality, we think the actual difference in opinions is not so large: our data suggested little evidence for a large battery of tests in EDI-, which was where rationalisation of investigations was recommended, but we encouraged further testing in EDI + based on phenotype [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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How paediatricians investigate early developmental impairment in the UK: a qualitative descriptive study

Atherton

Hart

2022

BMC Pediatr

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Background Early developmental impairment (EDI) is common and has many aetiologies and, therefore, potential investigations. There are several published guidelines recommending aetiological investigations, and paediatricians’ views of them varies. Little is known on the thought processes underlying clinical decisions in investigating EDI. This study aimed to describe the thought processes affecting clinical decisions on the investigation of EDI within a nationalised health care system. Methods A qualitative descriptive study using semi-structured qualitative interviews performed in person or via video link with paediatricians who see children with EDI in England. As part of the interview, a case study of a fictional disease, Cavorite deficiency, modelled on biotinidase deficiency, was given to participants with the cost of testing, incidence and likelihood it would respond to treatment. This allowed exploration of cost without encumbrance from predisposing views and training on the condition. Thematic analysis was performed by iterative approach. Where participants stated they wanted to redirect money from investigations to treatment, were that even possible, we asked which services they would like to be better funded in their area. Results Interviews were conducted with 14 consultant paediatricians: 9 Community / Neurodisability, 2 General paediatricians, and 3 Paediatric Neurologists. Two themes were identified: the value of an aetiological diagnosis to families and managing risk and probability when investigating EDI. The latter contained 4 subthemes: ‘circumspection’ involved blanket investigations chosen irrespective of phenotype and high regard for guidelines; ‘accepting appropriate risk’ involved participants choosing investigations based on clinical phenotype, recognising some aetiologies would be missed; consultants found they ‘transitioned between practices’ during their career; and ‘improved practice’ was thought possible with better evidence on how to stratify investigations based on phenotype. Services that were most frequently reported to need additional funding were therapy services, early community developmental services, management of behaviour, sleep and mental health, and educational support. Conclusions There are many factors that influence paediatricians’ choice of aetiological investigation in EDI, but clinical factors are the most important. Paediatricians want better evidence to allow them to select the right investigations for each child without a significant risk of missing an important diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

How paediatricians investigate early developmental impairment in the UK: a qualitative descriptive study

Atherton

Hart

2022

BMC Pediatr

View full text Add to dashboard Cite

show abstract

“…(22) This agrees with other groups' work. (1,13,21,(29)(30)(31) However, other publications extol the importance of diagnosing metabolic disorders, (19,20,23,(32)(33)(34) particularly where they are treatable. Such divergence in views was also seen amongst our participants.…”

Section: Discussionmentioning

confidence: 99%

“…The criticism we faced when recommending reducing amounts of investigations in EDI guidelines (23) was valid in many ways, including the observation that not every child in our cohort received the same investigations. In reality, we think the actual difference in opinions is not so large: our data suggested little evidence for a large battery of tests in EDI-, which was where rationalisation of investigations was recommended, but we encouraged further testing in EDI+ based on phenotype.…”

Section: Discussionmentioning

confidence: 99%

“…(21,22) These recommendations were controversial, with other groups arguing in favour of additional testing. (23) There is no published evidence on how paediatricians choose aetiological investigations for EDI. This qualitative descriptive study aimed to describe the thought processes and factors that affect clinicians' decisions on investigation choice in children with EDI seen within a nationalised health care system, where costs for patients and insurance company intervention play no role in clinical decision making.…”

Section: Introductionmentioning

confidence: 99%

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