Cargando…

The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study

Introduction: Clinical guidelines recommend using neuroimaging, Prechtls’ General Movements Assessment (GMA), and Hammersmith Infant Neurological Examination (HINE) to diagnose cerebral palsy (CP) in infancy. Previous studies provided excellent sensitivity and specificity for each test in isolation,...

Descripción completa

Detalles Bibliográficos
Autores principales: Morgan, Catherine, Romeo, Domenico M., Chorna, Olena, Novak, Iona, Galea, Claire, Del Secco, Sabrina, Guzzetta, Andrea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912336/
https://www.ncbi.nlm.nih.gov/pubmed/31694305
http://dx.doi.org/10.3390/jcm8111879
_version_ 1783479431977762816
author Morgan, Catherine
Romeo, Domenico M.
Chorna, Olena
Novak, Iona
Galea, Claire
Del Secco, Sabrina
Guzzetta, Andrea
author_facet Morgan, Catherine
Romeo, Domenico M.
Chorna, Olena
Novak, Iona
Galea, Claire
Del Secco, Sabrina
Guzzetta, Andrea
author_sort Morgan, Catherine
collection PubMed
description Introduction: Clinical guidelines recommend using neuroimaging, Prechtls’ General Movements Assessment (GMA), and Hammersmith Infant Neurological Examination (HINE) to diagnose cerebral palsy (CP) in infancy. Previous studies provided excellent sensitivity and specificity for each test in isolation, but no study has examined the pooled predictive power for early diagnosis. Methods: We performed a retrospective case-control study of 441 high-risk infants born between 2003 and 2014, from three Italian hospitals. Infants with either a normal outcome, mild disability, or CP at two years, were matched for birth year, gender, and gestational age. Three-month HINE, GMA, and neuroimaging were retrieved from medical records. Logistic regression was conducted with log-likelihood and used to determine the model fit and Area Under the Curve (AUC) for accuracy. Results: Sensitivity and specificity for detecting CP were 88% and 62% for three-month HINE, 95% and 97% for absent fidgety GMs, and 79% and 99% for neuroimaging. The combined predictive power of all three assessments gave sensitivity and specificity values of 97.86% and 99.22% (PPV 98.56%, NPV 98.84%). Conclusion: CP can be accurately detected in high-risk infants when these test findings triangulate. Clinical implementation of these tools is likely to reduce the average age when CP is diagnosed, and intervention is started.
format Online
Article
Text
id pubmed-6912336
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-69123362020-01-02 The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study Morgan, Catherine Romeo, Domenico M. Chorna, Olena Novak, Iona Galea, Claire Del Secco, Sabrina Guzzetta, Andrea J Clin Med Article Introduction: Clinical guidelines recommend using neuroimaging, Prechtls’ General Movements Assessment (GMA), and Hammersmith Infant Neurological Examination (HINE) to diagnose cerebral palsy (CP) in infancy. Previous studies provided excellent sensitivity and specificity for each test in isolation, but no study has examined the pooled predictive power for early diagnosis. Methods: We performed a retrospective case-control study of 441 high-risk infants born between 2003 and 2014, from three Italian hospitals. Infants with either a normal outcome, mild disability, or CP at two years, were matched for birth year, gender, and gestational age. Three-month HINE, GMA, and neuroimaging were retrieved from medical records. Logistic regression was conducted with log-likelihood and used to determine the model fit and Area Under the Curve (AUC) for accuracy. Results: Sensitivity and specificity for detecting CP were 88% and 62% for three-month HINE, 95% and 97% for absent fidgety GMs, and 79% and 99% for neuroimaging. The combined predictive power of all three assessments gave sensitivity and specificity values of 97.86% and 99.22% (PPV 98.56%, NPV 98.84%). Conclusion: CP can be accurately detected in high-risk infants when these test findings triangulate. Clinical implementation of these tools is likely to reduce the average age when CP is diagnosed, and intervention is started. MDPI 2019-11-05 /pmc/articles/PMC6912336/ /pubmed/31694305 http://dx.doi.org/10.3390/jcm8111879 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Morgan, Catherine
Romeo, Domenico M.
Chorna, Olena
Novak, Iona
Galea, Claire
Del Secco, Sabrina
Guzzetta, Andrea
The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study
title The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study
title_full The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study
title_fullStr The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study
title_full_unstemmed The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study
title_short The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study
title_sort pooled diagnostic accuracy of neuroimaging, general movements, and neurological examination for diagnosing cerebral palsy early in high-risk infants: a case control study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912336/
https://www.ncbi.nlm.nih.gov/pubmed/31694305
http://dx.doi.org/10.3390/jcm8111879
work_keys_str_mv AT morgancatherine thepooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT romeodomenicom thepooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT chornaolena thepooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT novakiona thepooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT galeaclaire thepooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT delseccosabrina thepooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT guzzettaandrea thepooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT morgancatherine pooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT romeodomenicom pooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT chornaolena pooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT novakiona pooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT galeaclaire pooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT delseccosabrina pooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy
AT guzzettaandrea pooleddiagnosticaccuracyofneuroimaginggeneralmovementsandneurologicalexaminationfordiagnosingcerebralpalsyearlyinhighriskinfantsacasecontrolstudy