Primary Care Providers' Initial Evaluation of Children with Global Developmental Delay: A Clinical Vignette Study.
J Pediatr
; 167(6): 1404-8.e1, 2015 Dec.
Article
em En
| MEDLINE
| ID: mdl-26477869
ABSTRACT
OBJECTIVE:
To examine the decisions of pediatric primary care physicians about their diagnostic evaluation for a child with suspected global developmental delay (GDD). STUDYDESIGN:
A 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.RESULTS:
More 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%).CONCLUSIONS:
When 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.
Texto completo:
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Bases de dados:
MEDLINE
Assunto principal:
Médicos de Família
/
Atenção Primária à Saúde
/
Padrões de Prática Médica
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Diagnóstico por Imagem
/
Deficiências do Desenvolvimento
/
Testes Genéticos
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
Limite:
Female
/
Humans
/
Infant
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Pediatr
Ano de publicação:
2015
Tipo de documento:
Article