070 Development, validation and implementation of the brief developmental assessment in pre-school children with heart disease. (December 2018)

• Record Type: Journal Article
• Authors: Hoskote, AU; Ridout, DA; Pagel, C; Kakat, S; Banks, V; Franklin, R; Witter, T; Lakhani, R; Lakhanpaul, M; Tsang, V; Brown, KL; Wray, J
• Is Part Of: Archives of disease in childhood. Volume 103(2018)Supplement 2
• Page Start: A28
• Page End: A29
• Publication Date: 2018-12
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/goshabs.70
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Background: Despite awareness of neurodevelopmental abnormalities in children with Congenital Heart Disease (CHD), there is no routine developmental monitoring of children with CHD in the United Kingdom. Method: An early recognition tool (Brief Developmental Assessment – BDA) was therefore developed using quality improvement methodology involving several iterations and rounds of pilot testing. An expert group of community paediatricians were then engaged to refine the tool and a scoring system developed which enabled categorisation as green (appropriate for age), red (delayed) or amber (equivocal). A convenience sample of 960 pre-school children with CHD from each of five age bands (0–4 months, 5–8 months, 9–14 months, 15 months-2.9 years, 3–4.9 years) were recruited from three UK tertiary cardiac centres as part of an NIHR-funded mixed-methods study. The BDA was prospectively validated using Mullen Scales of Early Learning (MSEL). Construct validity was based on BDA detection of children with known neurodevelopmental abnormalities, and sensitivity and specificity of BDA was evaluated against MSEL. The BDA was successfully validated in the older four age bands (not those <4 months) as pre-set validation thresholds were met (lower 95% confidence limit for the correlation coefficient >0.75) between two raters and with MSEL. Based on American Association of Paediatrics Guidelines, which state that the sensitivity and specificity of a developmental screening tool should fall between 70%–80%, the BDA outcome of 'red' met threshold for detection of MSEL scores>2 SD below the mean. A Delphi survey detailing two scenarios (a child identified with red BDA and a child identified with amber BDA) was sent to 80 professionals and stakeholders and agreement was obtained about a clear referral pathway. Conclusion: The BDA, along with a user-training package and an action guide, may be used to improve the quality of neurodevelopmental assessment of children with CHD, facilitating early detection and increased access to services.